下呼吸道感染患者分离的革兰阴性菌8年资料分析

Gramnegative bacteria isolated from patients with lower respiratory tract infection:a 8year data analysis

摘要:

目的了解某院下呼吸道革兰阴性（G-）菌感染者的病原菌分布及其耐药情况，为临床抗感染治疗提供依据。方法回顾性分析2002年1月—2009年12月8年间该院住院的下呼吸道感染患者痰液及支气管吸取物、胸腔积液标本细菌培养及药敏试验结果。结果8年共分离病原菌9 884株，其中G-菌6 358株（64.33%）。构成比居前列的G-菌为铜绿假单胞菌（33.41%）、不动杆菌属（20.51%）、克雷伯菌属（19.11%）、大肠埃希菌（12.65%）等。2008—2009年主要肠杆菌科细菌对碳青霉烯类药物美罗培南、亚胺培南耐药率低（＜3%），耐药率相对较低的抗菌药物有阿米卡星（17.37%～19.58%）、头孢哌酮/舒巴坦（10.67%～23.62%）、哌拉西林/他唑巴坦（13.58%～25.11%）等；铜绿假单胞菌对碳青霉烯类抗生素的耐药率已高达38.54%，耐药率相对较低的抗生素有阿米卡星(31.50%)及米诺环素（32.00%）；不动杆菌属耐药率较低的抗菌药物有碳青霉烯类（10.47%）、左氧氟沙星（24.64%）、阿莫西林/克拉维酸（24.33%）、头孢哌酮/舒巴坦（27.00%）及米诺环素（10.27%）。结论G-菌为该地区下呼吸道感染的主要病原菌，分离率居前列的G-菌对大多数抗菌药物的耐药性不断升高，应加强监测。

Abstract:

ObjectiveTo understand the distribution and drugresistance of gramnegative bactera isolated from lower respiratory tract in a hospital , so as to provide reference for antiinfection treatment in clinic.MethodsBacteria were isolated from sputum, bronchial aspiration,and pleural effusion of patients  admitted in  a hospital from January 2002 to December 2009, distribution and drug susceptibility test of bacteria  were analysed retrospectively.ResultsA total of 9 884 isolates of bacteria were isolated during 8 years, 6 358 (64.33%) of which were gramnegative bacteria . The main isolated bacteria were Pseudomonas aeruginosa(33.41%), Acinetobacter spp. (20.51%), Klebsiella spp.(19.11%) , and Escherichia coli(12.65%) . The main bacteria of Enterobacteriaceae had low resistance to carbapenems,such as meropenem and imipenem (<3%), and had relative lower resistance to amikacin(17.37%-19.58%), cefoperazone/sulbactam (10.67%-23.62%) , and piperacillin/tazobactam(13.58%-25.11%). The resistant rate of Pseudomonas aeruginosa to  carbapenems was up to 38.54% , and had relatively lower resistance to amikacin(31.50%) and minocycline(32.00%)； Acinetobacter spp. had relatively lower resistance to  carbapenems(10.47%), levofloxacin (24.64%) ,amoxicillin/clavulanic acid (24.33%), cefoperazone/sulbactam (27.00%) ,and minocycline(10.27%).ConclusionGramnegative bacteria are the major pathogens in lower respiratory tract infection  in this area, the main isolated bacteria have a rising resistance to most antimicrobial agents.