CAJ | 학술논문

目的：探讨呼吸内科下呼吸道感染患者常见病原菌分布及相关危险因素，为合理应用抗菌药物提供参考依据。方法收集2012年10月－2014年1月呼吸内科下呼吸道感染患者350份痰液标本，对其病原菌分布、耐药性进行统计分析，将350例下呼吸道感染患者作为观察组，另选取100例无下呼吸道感染患者作为对照组，对呼吸内科下呼吸道感染的相关危险因素进行 logistic回归分析。结果350份痰液标本中共分离出病原菌328株，其中革兰阴性菌228株占69．51％、革兰阳性菌31株占9．45％、真菌69株占21．04％；革兰阴性菌对美罗培南、亚胺培南等较敏感，耐药率＜30．00％，革兰阳性菌对常用抗菌药物耐药严重，仅对替考拉宁敏感，耐药率为0，真菌对伊曲康唑敏感；经 logistic回归性分析，气管插管或气管切开等有创操作、应用糖皮质激素、抗菌药物滥用、营养不良是呼吸内科下呼吸道感染的危险因素（P＜0．05）。结论呼吸内科下呼吸道感染以革兰阴性杆菌为主，耐药较严重，临床应针对下呼吸道感染的危险因素，合理应用抗菌药物，做好耐药菌的监测和预防控制。
목적：탐토호흡내과하호흡도감염환자상견병원균분포급상관위험인소，위합리응용항균약물제공삼고의거。방법수집2012년10월－2014년1월호흡내과하호흡도감염환자350빈담액표본，대기병원균분포、내약성진행통계분석，장350례하호흡도감염환자작위관찰조，령선취100례무하호흡도감염환자작위대조조，대호흡내과하호흡도감염적상관위험인소진행 logistic회귀분석。결과350빈담액표본중공분리출병원균328주，기중혁란음성균228주점69．51％、혁란양성균31주점9．45％、진균69주점21．04％；혁란음성균대미라배남、아알배남등교민감，내약솔＜30．00％，혁란양성균대상용항균약물내약엄중，부대체고랍저민감，내약솔위0，진균대이곡강서민감；경 logistic회귀성분석，기관삽관혹기관절개등유창조작、응용당피질격소、항균약물람용、영양불량시호흡내과하호흡도감염적위험인소（P＜0．05）。결론호흡내과하호흡도감염이혁란음성간균위주，내약교엄중，림상응침대하호흡도감염적위험인소，합리응용항균약물，주호내약균적감측화예방공제。
OBJECTIVE To explore the distribution of common pathogens causing lower respiratory tract infections in the patients of respiratory medicine department and analyze the related risk factors so as to provide guidance for reasonable use of antibiotics .METHODS Totally 350 sputum specimens were collected from the patients with lower respiratory tract infections who were treated in the respiratory medicine department from Oct 2012 to Jan 2014 , then the distribution and drug resistance of the pathogens were statistically analyzed .A total of 350 patients with lower respiratory tract infections were assigned as the observation group ,while 100 patients without lower respira‐tory tract infections were chosen as the control group ;the logistic regression analysis was performed for the relat‐ed risk factors for the lower respiratory tract infections in the patients of the respiratory medicine department . RESULTS A total of 328 strains of pathogens have been isolated from the 350 sputum specimens ,including 228 (69 .51% ) strains of gram‐negative bacteria ,31 (9 .45% ) strains of gram‐positive bacteria ,and 69 (21 .04% ) strains of fungi .The drug resistance rates of the gram‐negative bacteria to meropenem ,and imipenem were less than 30 .00% ;the gram‐positive bacteria were highly resistant to the commonly used antibiotics and were only susceptible to teicoplanin ,with the drug resistance rate of 0;the fungi were susceptible to itraconazole .The logis‐tic regression analysis indicated that the invasive operations such as endotracheal intubation and tracheotomy ,use of glucocorticoids ,abuse of antibiotics ,and malnutrition were the risk factors for the lower respiratory tract infec‐tions in the patients of respiratory medicine department (P<0 .05) .CONCLUSION The gram‐negative bacilli are dominant among the pathogens causing the lower respiratory tract infections in the patients of respiratory medicine department and are highly drug‐resistant .It is necessary for the hospital to reasonably use antibiotics aiming at the risk factors and conduct the surveillance ,control ,and prevention of the drug‐resistant strains .