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目的分析某院呼吸内科下呼吸道住院患者痰标本病原菌分布情况及耐药特征,为临床治疗提供参考依据。方法收集2010年3月-2013年10月间,该院呼吸内科住院治疗的下呼吸道感染患者1 543例进行痰液标本检验,分析标本中病原菌的检出情况及主要致病菌对常用抗菌药的耐药情况。结果 1 543名患者送检标本中,分离得到病原菌689份,检出率为44.6%。共分离出革兰阴性菌431株(62.6%),革兰阳性菌203株(29.5%),真菌55株(8.0%)。在革兰阴性菌中,铜绿假单胞菌所占构成比最高(19.3%),其次为肺炎克雷伯菌102株(14.8%);革兰阳性菌中所占比例最大的为肺炎链球菌(12.2%),其次为金黄色葡萄球菌53株(7.7%);白假丝酵母菌在真菌中所占比例最大(3.5%)。铜绿假单胞菌耐药最严重的几种药物分别为头孢曲松(92.1%)、头孢噻肟(84.3%)及奈替米星(52.7%);肺炎克雷伯菌耐药较为严重的几种药物为环丙沙星(59.1%)、庆大霉素(58.6%)以及阿莫西林克拉维酸(53.2%);鲍曼不动杆菌耐药率较高的几种药物为阿莫西林克拉维酸(99.4%)、氨曲南(91.1%)以及头孢噻肟(81.0%)。在革兰阳性菌种,肺炎链球菌耐药率较高的药物为四环素(97.3%)、红霉素(92.7%)以及环丙沙星(90.5%);金黄色葡萄球菌耐药较为严重的几种药物为红霉素(95.4%)、庆大霉素(91.6%)及四环素(90.0%);表皮葡萄球菌耐药严重的几种药物为红霉素(98.3%)、四环素(91.9%)及庆大霉素(90.5%)。结论在该院呼吸内科住院患者中,革兰阴性菌感染所占比例较高,其中铜绿假单胞菌成为革兰阴性菌中的主要致病菌。各类致病菌的耐药率也不尽相同,临床治疗时应根据致病菌检验结果及药敏实验合理治疗用药。
Objective To analyze the distribution and drug resistance characteristics of pathogenic bacteria in the sputum of hospitalized patients with respiratory tract in the lower respiratory tract of a hospital and provide a reference for clinical treatment. Methods From March 2010 to October 2013, 1 543 patients with lower respiratory tract infection in hospital were enrolled in this study. The sputum samples were collected and the detection of pathogenic bacteria in the samples and the detection of common pathogens in common antibacterials The resistance situation. Results A total of 689 pathogens were isolated from 1 543 patients and the detection rate was 44.6%. 431 strains of Gram-negative bacteria (62.6%), 203 (29.5%) of Gram-positive bacteria and 55 (8.0%) of fungi were isolated. In Gram-negative bacteria, Pseudomonas aeruginosa accounted for the highest proportion (19.3%), followed by 102 strains of Klebsiella pneumoniae (14.8%); Gram-positive bacteria accounted for the largest proportion of Streptococcus pneumoniae (12.2%), followed by Staphylococcus aureus 53 (7.7%); Candida albicans in fungi accounted for the largest (3.5%). Several drug-resistant strains of Pseudomonas aeruginosa were ceftriaxone (92.1%), cefotaxime (84.3%) and netilmicin (52.7%). Klebsiella pneumoniae was more resistant Several drugs for ciprofloxacin (59.1%), gentamicin (58.6%) and amoxicillin clavulanic acid (53.2%); Acinetobacter the higher the rate of several drugs for Amo (99.4%), aztreonam (91.1%), and cefotaxime (81.0%). Among the Gram-positive bacteria, the drug resistant to S. pneumoniae was tetracycline (97.3%), erythromycin (92.7%) and ciprofloxacin (90.5%). Staphylococcus aureus was more resistant Several drugs were erythromycin (95.4%), gentamicin (91.6%) and tetracycline (90.0%). Several drugs resistant to Staphylococcus epidermidis were erythromycin (98.3%), tetracycline (91.9% ) And gentamicin (90.5%). Conclusion Among the inpatients in the department of respiratory medicine in the hospital, the proportion of Gram-negative bacteria is high, and Pseudomonas aeruginosa is the main pathogen in Gram-negative bacteria. The rate of resistance of various types of pathogens are not the same, clinical treatment should be based on pathogen test results and drug susceptibility testing reasonable treatment medication.