83例成人下呼吸道感染的病原菌分布及耐药分析

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英文篇名：Distribution of Pathogens and Drug Resistance in 83 Adults with Lower Respiratory Tract Infection 作者：何婕 ; 刘琼 ; 何玥 英文作者：HE Jie;LIU Qiong;HE Yue;Shenzhen Shajing People's Hospital Affiliated to Guangzhou Medical University; 关键词：下呼吸道感染 ; 病原菌 ; 耐药性 英文关键词：Lower respiratory tract infections;;Pathogenic bacteria;;Drug resistance 中文刊名：YJZY 英文刊名：Chinese and Foreign Medical Research 机构：广州医科大学附属深圳沙井人民医院; 出版日期：2019-05-25 出版单位：中外医学研究 年：2019 期：v.17;No.419 语种：中文; 页：YJZY201915076 页数：3 CN：15 ISSN：23-1555/R 分类号：167-169

摘要

目的:探究和分析下呼吸道感染的病原菌分布及耐药性。方法:选择笔者所在医院2018年1月-2018年6月收治的83例成人下呼吸道感染患者作为研究对象,采集所有患者痰液标本行细菌分离培养及鉴定,总结其痰液标本中病原菌分布情况和分析不同病原菌的耐药性。结果:83例患者共检出1株真菌(白色念珠菌),占比1.2%;19株革兰阳性菌,占比22.9%,包含肺炎链球菌7株、金黄色葡萄球菌5株、星座链球菌3株及其他菌4株;63株革兰阴性菌,占比75.9%,包含铜绿假单胞菌23株、肺炎克雷伯菌17株、鲍曼不动杆菌9株、流感嗜血杆菌8株及其他菌6株。多数革兰阳性菌对左氧氟沙星、环丙沙星、替加环素、莫西沙星、利奈唑胺、万古霉素等抗菌药物具有较高敏感性,对红霉素出现较高耐药性;金黄色葡萄球菌对青霉素、克林霉素分别呈100%、40%的耐药;肺炎链球菌对四环素、甲氧苄啶/磺胺甲噁唑分别呈85.7%、42.9%的耐药;粪肠球菌对四环素呈100%的耐药。多数革兰阴性菌如摩根摩根菌、奇异变形杆菌、阴沟肠杆菌对各抗菌药物均表现出较高的敏感性,而鲍曼不动杆菌与大肠埃希菌则普遍表现较高的耐药性,对头孢类、喹诺酮类药物呈较高的耐药率;铜绿假单胞菌对庆大霉素呈13.0%的耐药率;肺炎克雷伯菌对氨苄西林-舒巴坦、头孢曲松、甲氧苄啶/磺胺甲噁唑分别呈29.4%、29.4%、23.5%的耐药率。结论:下呼吸道感染病原菌以革兰阴性菌为主,不同病原菌对各类抗生素药物耐药性均有一定的差异,临床需根据药敏结果合理采用抗生素药物对患者治疗,才能降低患者耐药性和提升其抗感染治疗效果。
        Objective:To investigate the distribution and drug resistance of pathogenic bacteria in lower respiratory tract infections.Method:83 adult patients with lower respiratory tract infection admitted to our hospital from January 2018 to June 2018 were selected as the subjects of study.The sputum samples of all patients were collected for bacterial isolation,culture and identification.The distribution of pathogenic bacteria in specimens and drug resistance of different pathogenic bacteria were analysed.Result:There detected one strain of fungi(Candida albicans,1.2%).There detected 19 Gram-positive bacteria(22.9%),including Streptococcus pneumoniae(7 strains),Staphylococcus aureus(5 strains),Streptococcus constellatus(3 strains) and other bacteria(4 strains).And there detected 63 Gram-negative bacteria(75.9%),including Pseudomonas aeruginosa(23 strains),klebsiella pneumoniae(17 strains),Acinetobacter baumannii(9 strains),Haemophilus influenzae(8 strains) and other bacteria(6 strains).In all the test results,most Gram-positive bacteria were highly sensitive to levofloxacin,ciprofloxacin,tigacycline,moxifloxacin,linezolid and vancomycin,and showed high resistance to erythromycin.Staphylococcus aureus was 100% and 40%resistant to penicillin and clindamycin,respectively.Streptococcus pneumoniae was resistant to tetracycline,trimethoprim/sulfamethoxazole.Azole was 85.7%and 42.9% resistant,while Enterococcus faecalis was 100% resistant to tetracycline.Among all the test results,most Gram-negative bacteria such as Morgan,Proteus mirabilis and Enterobacter cloacae showed high sensitivity to antibiotics,while Acinetobacter baumannii and Escherichia coli showed high resistance to cephalosporins and quinolones,and Pseudomonas aeruginosa showed 13.0% resistance to gentamicin.Resistance rates of Rabsiella to ampicillin-sulbactam,ceftriaxone and trimethoprim/sulfamethoxazole were 29.4%,29.4% and 23.5% respectively.Conclusion:Gram-negative bacteria are the main pathogens of lower respiratory tract infections.The resistance of different pathogens to various antibiotics is different.In order to reduce drug resistance and enhance the anti-infection effect of patients,antibiotics should be reasonably used according to the results of drug sensitivity.

引文

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