国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2010年
24期
1485-1489
,共5页
吴巧珍%胡晓蕴%吴文英%钱雄杰
吳巧珍%鬍曉蘊%吳文英%錢雄傑
오교진%호효온%오문영%전웅걸
下呼吸道感染%微生物敏感试验%细菌耐药性监测
下呼吸道感染%微生物敏感試驗%細菌耐藥性鑑測
하호흡도감염%미생물민감시험%세균내약성감측
Lower respiratory tract infection%Antimicrobial susceptibility test%Bacterial drug resistance monitoring
目的 调查我院近3年下呼吸道感染主要病原菌的分布与耐药情况,并以重症监护病房(ICU)与非ICU相比较,观察两者的不同之处,为临床合理选用抗菌药物提供依据.方法 使用VITEK2-compact微生物检测系统对我院下呼吸道感染住院患者的痰液标本中临床分离的941株病原菌进行细菌鉴定,采用MIC法进行药敏试验.结果 临床分离的941株细菌中,368株来自ICU,革兰阴性杆菌占85.02%(800/941).ICU与非ICU耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为100.00%(25/25)和73.53%(25/34)(P＜0.01).病原菌中最常见的菌种依次为肺炎克雷伯菌21.15%(199/941)、铜绿假单胞菌20.30%(191/941)、鲍曼不动杆菌10.31%(97/941)、嗜麦芽窄食单胞菌7.97%(75/941)和大肠埃希菌7.44%(70/941),ICU与非ICU前5位病原菌相同,但构成比例不同.肺炎克雷伯菌和大肠埃希菌产生超广谱β-内酰胺酶(ESBL)的检出率分别为57.79%(115/199)和51.43%(36/70),ICU的ESBL检出率与非ICU比较差异具有统计学意义(P＜0.05).肺炎克雷伯菌、大肠埃希菌对亚胺培南敏感度最高,耐药率分别为5.06%和18.18%;铜绿假单胞菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、环丙沙星、头孢吡肟、亚胺培南、阿米卡星的耐药率在18.52%～27.66%之间;鲍曼不动杆菌耐药情况比较严重,只有对加替沙星和亚胺培南的耐药率低于30%;嗜麦芽窄食单胞菌耐药情况最严重,只对复方磺胺甲噁唑高度敏感,耐药率为9.09%,对头孢曲松、头孢噻肟、哌拉西林、阿莫西林/舒巴坦钠和亚胺培南几乎全部耐药.我院存在较高的复合感染率,为11.62%(84/723),主要发生在ICU,复合感染率及感染株数在2009年监测中明显下降.结论 革兰阴性杆菌为医院下呼吸道感染主要病原菌,且呈现多重耐药趋势.亚胺培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦是治疗下呼吸道感染的有效药物.动态监测细菌的耐药性,合理选择抗生素,减少高危因素并制定有效的防治措施显得至关重要.
目的 調查我院近3年下呼吸道感染主要病原菌的分佈與耐藥情況,併以重癥鑑護病房(ICU)與非ICU相比較,觀察兩者的不同之處,為臨床閤理選用抗菌藥物提供依據.方法 使用VITEK2-compact微生物檢測繫統對我院下呼吸道感染住院患者的痰液標本中臨床分離的941株病原菌進行細菌鑒定,採用MIC法進行藥敏試驗.結果 臨床分離的941株細菌中,368株來自ICU,革蘭陰性桿菌佔85.02%(800/941).ICU與非ICU耐甲氧西林金黃色葡萄毬菌(MRSA)的檢齣率分彆為100.00%(25/25)和73.53%(25/34)(P＜0.01).病原菌中最常見的菌種依次為肺炎剋雷伯菌21.15%(199/941)、銅綠假單胞菌20.30%(191/941)、鮑曼不動桿菌10.31%(97/941)、嗜麥芽窄食單胞菌7.97%(75/941)和大腸埃希菌7.44%(70/941),ICU與非ICU前5位病原菌相同,但構成比例不同.肺炎剋雷伯菌和大腸埃希菌產生超廣譜β-內酰胺酶(ESBL)的檢齣率分彆為57.79%(115/199)和51.43%(36/70),ICU的ESBL檢齣率與非ICU比較差異具有統計學意義(P＜0.05).肺炎剋雷伯菌、大腸埃希菌對亞胺培南敏感度最高,耐藥率分彆為5.06%和18.18%;銅綠假單胞菌對頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦、環丙沙星、頭孢吡肟、亞胺培南、阿米卡星的耐藥率在18.52%～27.66%之間;鮑曼不動桿菌耐藥情況比較嚴重,隻有對加替沙星和亞胺培南的耐藥率低于30%;嗜麥芽窄食單胞菌耐藥情況最嚴重,隻對複方磺胺甲噁唑高度敏感,耐藥率為9.09%,對頭孢麯鬆、頭孢噻肟、哌拉西林、阿莫西林/舒巴坦鈉和亞胺培南幾乎全部耐藥.我院存在較高的複閤感染率,為11.62%(84/723),主要髮生在ICU,複閤感染率及感染株數在2009年鑑測中明顯下降.結論 革蘭陰性桿菌為醫院下呼吸道感染主要病原菌,且呈現多重耐藥趨勢.亞胺培南、頭孢哌酮/舒巴坦和哌拉西林/他唑巴坦是治療下呼吸道感染的有效藥物.動態鑑測細菌的耐藥性,閤理選擇抗生素,減少高危因素併製定有效的防治措施顯得至關重要.
목적 조사아원근3년하호흡도감염주요병원균적분포여내약정황,병이중증감호병방(ICU)여비ICU상비교,관찰량자적불동지처,위림상합리선용항균약물제공의거.방법 사용VITEK2-compact미생물검측계통대아원하호흡도감염주원환자적담액표본중림상분리적941주병원균진행세균감정,채용MIC법진행약민시험.결과 림상분리적941주세균중,368주래자ICU,혁란음성간균점85.02%(800/941).ICU여비ICU내갑양서림금황색포도구균(MRSA)적검출솔분별위100.00%(25/25)화73.53%(25/34)(P＜0.01).병원균중최상견적균충의차위폐염극뢰백균21.15%(199/941)、동록가단포균20.30%(191/941)、포만불동간균10.31%(97/941)、기맥아착식단포균7.97%(75/941)화대장애희균7.44%(70/941),ICU여비ICU전5위병원균상동,단구성비례불동.폐염극뢰백균화대장애희균산생초엄보β-내선알매(ESBL)적검출솔분별위57.79%(115/199)화51.43%(36/70),ICU적ESBL검출솔여비ICU비교차이구유통계학의의(P＜0.05).폐염극뢰백균、대장애희균대아알배남민감도최고,내약솔분별위5.06%화18.18%;동록가단포균대두포고동/서파탄、고랍서림/타서파탄、배병사성、두포필우、아알배남、아미잡성적내약솔재18.52%～27.66%지간;포만불동간균내약정황비교엄중,지유대가체사성화아알배남적내약솔저우30%;기맥아착식단포균내약정황최엄중,지대복방광알갑오서고도민감,내약솔위9.09%,대두포곡송、두포새우、고랍서림、아막서림/서파탄납화아알배남궤호전부내약.아원존재교고적복합감염솔,위11.62%(84/723),주요발생재ICU,복합감염솔급감염주수재2009년감측중명현하강.결론 혁란음성간균위의원하호흡도감염주요병원균,차정현다중내약추세.아알배남、두포고동/서파탄화고랍서림/타서파탄시치료하호흡도감염적유효약물.동태감측세균적내약성,합리선택항생소,감소고위인소병제정유효적방치조시현득지관중요.
Objective To investigate the distribution and drug resistance of pathogenic bacteria in lower respiratory tract infection in the hospital in recent three years and to provide a basis for the clinical reasonable use of antibacterials through comparing the bacteria obtained from intensive care unit (ICU)and non-ICU. Methods 941 strains of pathogenic bacteria clinically isolated from sputum specimen of hospital patients with lower respiratory tract infection were identified by VITEK2-compact microbial detection system. The bacterial susceptibility test was made by MIC method. Results Among the isolated 941 strains of bacteria,368 strains were from ICU,gram-negative bacilli accounted for 85.02% (800/941).The detection rates of methicilli-resistant Staphylococcus aureus from ICU and non-ICU were 100.00%(25/25) and 73.53% (25/34)( P ＜0.01). The most common pathogens were Klebsiella pneumoniae (21.15%, 199/941 ), Pseudomonas aeruginosa ( 20.30%, 191/941 ), Acinetobacter baumanni ( 10. 31%,97/941 ), Stenotrophomonas maltophilia ( 7.97 %, 75/941 ) and Escherichia coli ( 7.44 %, 70/941 ). The detection rates of extended spectrum β-lactamases (ESBL) in Klebsiella pneumoniae and Escherichia coli were 57.79% ( 115/199 ) and 51.43% (36/70), respectively. There was statistical difference on the detection rate of ESBI between ICU and non-ICU ( P ＜0.05). Klebsiella pneumoniae and Escherichia coli were the most sensitive to imipenem, the resistance rates of them were 5.06 % and 18.18 %, respectively.The drug resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,piperacillin/tazobactam,ciprofloxacin, cefepime, imipenem, amikacin were between 18. 52 % and 27.66 %. The drug resistance rate of Acinetobacter baumanni to gatifloxacin and imipenem were both less than 30%. Stenotrophomonas maltophilia was only highly sensitive to sulfamethoxazole, the resistance rate was 9. 09%, and it was almost drug-resistant to ceftriaxone, cefotaxime, piperacillin, amoxicillin/sulbactam and imipenem. The rate of complex infection was higher in our hospital (11.62 %, 84/723), especially in ICU. The rate of complex infection and the number of infection strains obviously declined in 2009. Conclusions Gram-negative bacilli are main pathogens in patients with lower respiratory tract infection in the hospital, and most of them are multidrug resistant. Imipenem, cefoperazone/sulbactam and piperacillin/tazobactam are effective antibiotics for treating lower respiratory tract infection. Dynamic monitoring of bacterial resistance,reasonable choice of antibiotics,reduction of risk factors and effective control measures are crucial.
