CAJ | 학술논문

目的：了解医院获得性下呼吸道感染病原菌的构成及耐药性，为临床合理使用抗菌药物提供依据。方法对2014年1~12月943例发生医院获得性下呼吸道感染患者的痰培养和药敏结果进行回顾性统计分析。结果共分离出病原菌1056株，来源于重症监护病房(ICU)598株(56.6%)，其中革兰阴性菌863株(81.7%)，革兰阳性菌70株(6.6%)，真菌123株(11.6%)，最常见的革兰阴性菌依次为肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌，分别占22.5%(238/1056)、21.4%(226/1056)、19.2%(203/1056)和7.7%(81/1056)；最常见的革兰阳性菌为金黄色葡萄球菌占5.3%(56/1056)；最常见的真菌为白色假丝酵母菌占6.7%(71/1056)。鲍曼不动杆菌和铜绿假单胞菌对多种抗菌药物耐药，其中对碳青霉烯类抗菌药物的耐药率分别大于75%和50%；耐甲氧西林金黄色葡萄球菌(MRSA)检出率为78.6%(44/56)，未发现耐万古霉素金黄色葡萄球菌和肠球菌。结论病原菌以革兰阴性菌为主，对常用抗菌药物表现为高度耐药和多重耐药，耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯鲍曼不动杆菌(CR-AB)和铜绿假单胞菌(CR-PA)检出率高，加强病原学和耐药性监测，对于指导临床合理应用抗菌药物具有重要意义。
목적：료해의원획득성하호흡도감염병원균적구성급내약성，위림상합리사용항균약물제공의거。방법대2014년1~12월943례발생의원획득성하호흡도감염환자적담배양화약민결과진행회고성통계분석。결과공분리출병원균1056주，래원우중증감호병방(ICU)598주(56.6%)，기중혁란음성균863주(81.7%)，혁란양성균70주(6.6%)，진균123주(11.6%)，최상견적혁란음성균의차위폐염극뢰백균、포만불동간균、동록가단포균화대장애희균，분별점22.5%(238/1056)、21.4%(226/1056)、19.2%(203/1056)화7.7%(81/1056)；최상견적혁란양성균위금황색포도구균점5.3%(56/1056)；최상견적진균위백색가사효모균점6.7%(71/1056)。포만불동간균화동록가단포균대다충항균약물내약，기중대탄청매희류항균약물적내약솔분별대우75%화50%；내갑양서림금황색포도구균(MRSA)검출솔위78.6%(44/56)，미발현내만고매소금황색포도구균화장구균。결론병원균이혁란음성균위주，대상용항균약물표현위고도내약화다중내약，내갑양서림금황색포도구균(MRSA)、내탄청매희포만불동간균(CR-AB)화동록가단포균(CR-PA)검출솔고，가강병원학화내약성감측，대우지도림상합리응용항균약물구유중요의의。
Objective To explore the distribution and resistance analysis of pathogens causing hospital-acquired lower respiratory tract infection in order to provide reference for the clinical reasonable application of antibiotics. Methods The results of sputum cultivation and drug susceptibility of 943 patients with hospital-acquired lower respiratory tract infection in our hospital from Jan 2014 to Dec 2014 were analyzed retrospectively.Results Totally 1 056 strains of pathogens have been isolated,598 strains (56.6%)were isolated in ICU,including 863 (81.7%) strains of gram-negative bacteria,70(6.6%)strains of gram-positive bacteria and 123 (1 1.6%)strains of fungus . Klebsiella peneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichiacoli, were the most common gram-negative bacteria,accounting for 22.5%(238/1056),21.4%(226/1056),1 9.2%(203/1056),7.7%(81/1056),respectively.Staphylococcus aureus was the most common gram-positive bacteria,accounting for 5.3%. Candida albicans was the most common fungus,accounting for 6.7% (71/1056 ).Acinetobacter baumannii and Pseudomonas aeruginosa were resistant to multiple antibiotics,the drug resistance rate to carbapenems were more than 75% and 50%, respectively. The detection rates of the metihcillin-resistant S.aureus were 78.6% (44/56 ), Vancomycin-resistant S.aureus and Enterococcus were not detected.Conclusion Gram- negative bacteria was the predominant pathogens .The results of drug sensitive test showed the Gram-negative bacteria were highly and multiple resistant to common antibacterial.The incidence of MRSA,CR-AB and CR-PA was high.Strengthened monitoring of etiology and drug resistance is of great significance in guiding reasonable application of antibiotics .