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目的调查医院获得性下呼吸道感染病原菌分布及其耐药性情况,为临床合理使用抗菌药物提供参考。方法采用回顾性调查的方法,对医院2004年1月~2008年12月发生下呼吸道医院感染的患者呼吸道分泌物进行细菌培养和药敏试验。结果共分离到598株病原菌,其中革兰阴性菌461株(77.1%),主要为铜绿假单胞菌167株(27.9%)、肺炎克雷伯菌85株(14.2%)、鲍氏不动杆菌64株(10.7%);革兰阳性菌137株(22.9%),以金黄色葡萄球菌95株(15.9%)和凝固酶阴性葡萄球菌32株(5.4%)为主;上述常见细菌,均表现出了极高的多药耐药性,其中铜绿假单胞菌和鲍氏不动杆菌对头孢哌酮/舒巴坦仍保持了较高的敏感性,而肠杆菌科细菌则对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南耐药率较低;金黄色葡萄球菌和凝固酶阴性葡萄球菌尚未发现对万古霉素耐药。结论医院获得性下呼吸道感染临床分离病原以革兰阴性杆菌为主,感染菌的耐药性高,临床上及时掌握医院病原菌变化规律及耐药情况,可以更有效地预防和治疗下呼吸道获得性感染。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in hospital-acquired lower respiratory tract infection and provide references for the rational use of antibacterials in clinic. Methods A retrospective survey was conducted to evaluate the bacterial culture and drug sensitivity test of respiratory secretions of patients with lower respiratory tract nosocomial infection in hospital from January 2004 to December 2008. Results A total of 598 strains of pathogens were isolated, of which 461 (77.1%) were Gram-negative, including 167 (27.9%) Pseudomonas aeruginosa, 85 (14.2%) Klebsiella pneumoniae, 64 (10.7%) were bacillus, 137 (22.9%) were Gram-positive bacteria, accounting for 95 strains (15.9%) of Staphylococcus aureus and 32 strains (5.4%) of coagulase-negative staphylococci Showed a high multidrug resistance, which Pseudomonas aeruginosa and Acinetobacter baumanni cefoperazone / sulbactam still maintained a high sensitivity, while Enterobacteriaceae cefoperazone Ketone / sulbactam, piperacillin / tazobactam, imipenem lower resistance; Staphylococcus aureus and coagulase-negative staphylococci have not been found vancomycin resistance. Conclusions The clinical isolates of hospital-acquired lower respiratory tract infections are mainly Gram-negative bacilli. The drug-resistant strains are highly resistant. The change rules and drug resistance of the pathogenic bacteria in the hospital can be controlled in a timely manner, which can effectively prevent and treat the acquired lower respiratory tract infection.