论文部分内容阅读
目的:了解我院重症社区获得性肺炎(SCAP)的主要病原菌及耐药情况,为临床合理使用抗菌药物提供数据参考。方法:回顾性分析283例SCAP患者的支气管肺泡灌洗液(BALF)中病原菌分布及耐药情况。结果:共分离培养出病原菌163例,其中G-菌114例(69.94%),G+菌43例(26.38%),真菌6例(3.68%)。G-菌前4位为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌,药敏示肺炎克雷伯菌、大肠埃希菌对头孢替坦、哌拉西林/他唑巴坦、阿米卡星、亚胺培南等较敏感,但铜绿假单胞菌和鲍曼不动杆菌耐药严重,对多种抗菌药物高度耐药;G+菌前3位为肺炎链球菌、金黄色葡萄球菌、粪肠球菌,其中肺炎链球菌、金黄色葡萄球菌对哌拉西林/他唑巴坦、头孢拉定、利福平、左氧氟沙星等敏感率较高,但粪肠球菌均为多重耐药菌,未检出耐万古霉素G+菌株;真菌较少见,对氟康唑,两性霉素B等均较为敏感。结论:SCAP病原菌以G-菌为主,临床应依据SCAP病原学及耐药情况,选择合理有效的抗感染治疗方案,以延缓耐药菌株的蔓延,减少新的耐药菌株的出现。
Objective: To understand the major pathogens and drug resistance of SCAP in our hospital and provide data reference for the rational use of antibacterials in clinic. Methods: The distribution and drug resistance of pathogens in bronchoalveolar lavage fluid (BALF) of 283 SCAP patients were retrospectively analyzed. Results: A total of 163 pathogenic bacteria were isolated and cultured, of which 114 were G-bacteria (69.94%), 43 (26.38%) were G + bacteria and 6 (3.68%) were fungi. The top 4 G-bacteria were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella pneumoniae, Escherichia coli, cefotetan, Xilin / tazobactam, amikacin, imipenem and other more sensitive, but Pseudomonas aeruginosa and Acinetobacter baumanii severe resistance to a variety of antimicrobial drugs highly resistant; G + bacteria in the first three For Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis, Streptococcus pneumoniae, Staphylococcus aureus on piperacillin / tazobactam, cefradine, rifampicin, levofloxacin and other high sensitivity, but Enterococcus faecalis Were multi-resistant bacteria, vancomycin-resistant G + strains were not detected; fungi are rare, more sensitive to fluconazole, amphotericin B and so on. Conclusion: The main pathogens of SCAP are G-bacteria. According to the etiopathogenisis and the drug-resistant status of SCAP, we should choose a reasonable and effective anti-infective therapy to delay the spread of drug-resistant strains and reduce the emergence of new drug-resistant strains.