CAJ | 학술논문

目的：了解我院下呼吸道感染患者的病原菌分布及其耐药情况，为临床合理选用抗菌药物提供用药参考。方法回顾性分析1263例下呼吸道感染患者的病原菌分布及其耐药性。结果1263例痰标本共分离出病原菌453例，其中革兰氏阴性菌(G-)317例(70.0%)，革兰氏阳性菌(G+)91例(20.1%)，真菌45例(9.9%)。位列前6位的病原菌依次为肺炎克雷伯菌、流感嗜血杆菌、肺炎链球菌、大肠埃希菌、铜绿假单胞菌和金黄色葡萄球菌。药敏结果显示G-对亚胺培南，头孢吡肟耐药率最低，其次为哌拉西林他唑巴坦、头孢哌酮舒巴坦、头孢他啶、头孢唑肟等；G+对去甲万古霉素耐药率最低，其次为头孢唑林、头孢拉定、头孢呋辛、苯唑西林等；真菌对氟康唑、两性霉素B等均较为敏感。结论我院下呼吸道感染病原菌以G-为主，其次是G+、真菌。经验治疗可选择头孢三代，哌拉西林他唑巴坦，苯唑西林等抗菌药物。多重耐药菌可根据药敏结果选择头孢四代、亚胺培南、去甲万古霉素等治疗或联合用药。
목적：료해아원하호흡도감염환자적병원균분포급기내약정황，위림상합리선용항균약물제공용약삼고。방법회고성분석1263례하호흡도감염환자적병원균분포급기내약성。결과1263례담표본공분리출병원균453례，기중혁란씨음성균(G-)317례(70.0%)，혁란씨양성균(G+)91례(20.1%)，진균45례(9.9%)。위렬전6위적병원균의차위폐염극뢰백균、류감기혈간균、폐염련구균、대장애희균、동록가단포균화금황색포도구균。약민결과현시G-대아알배남，두포필우내약솔최저，기차위고랍서림타서파탄、두포고동서파탄、두포타정、두포서우등；G+대거갑만고매소내약솔최저，기차위두포서림、두포랍정、두포부신、분서서림등；진균대불강서、량성매소B등균교위민감。결론아원하호흡도감염병원균이G-위주，기차시G+、진균。경험치료가선택두포삼대，고랍서림타서파탄，분서서림등항균약물。다중내약균가근거약민결과선택두포사대、아알배남、거갑만고매소등치료혹연합용약。
Objective To analyze the pathogens distribution and drug resistance in patients with lower re-spiratory tract-infections in the hospital so as to provide appropriate clinical treatment. Methods By retrospective analysis of 1 263 cases of pathogens distribution and drug resistance in patients with lower respiratory tract infec-tions. Results There were 453 cases with pathogenic bacteria in the sputum specimens. Among them there were 317 Gram-negative bacteria (G-) cases (accounting for 70.0%), 91 Gram-positive bacteria (G+) cases (20.1%), and 45 fungus cases (9.9%). The top six of pathogens were Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneu-moniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. The results of drug susceptibility test showed that G-were most sensitive to imipenem, cefepime, followed by piperacillin tazobactam, cefoperazone sulbac-tam, ceftazidime, and ceftizoxime;G+were most sensitive to norvancomycin, cefazolin, cephradine, cefuroxime, and oxacillin; while fungi were sensitive to both fluconazole and amphotericin B. Conclusion In all the pathogens of lower respiratory tract infection, G- was in the majority, followed by G+ and the fungi. Therefore, third generation cephalosporin, piperacillin-tazobactam and oxacillin can be adopted in the empiric treatment. While with multiple re-sistant bacteria, fourth generations cephalosporin, imipenem, norvancomycin, or combination of drugs can be consid-ered according to the susceptibility results.