论文部分内容阅读
目的了解社区获得性肺炎病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法选取2013年10月-2015年10月间天津市泰达医院558例CAP患者的痰培养结果、血清学检测结果及药物敏感试验结果进行回顾性分析。结果 343例患者的病原学检测阳性,占全部患者的61.47%,其中革兰阴性菌228例,占比66.47%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌为主,分别占25.36%、13.99%、7.58%及6.12%;革兰阳性菌72例,占比20.99%,以金黄色葡萄球菌、表皮葡萄球菌为主,分别占7.58%、5.25%;真菌检出6例,占比1.75%;血清学检测结果阳性37例,其中肺炎支原体占比5.83%,肺炎衣原体占比4.96%;革兰阴性杆菌对三代和四代头孢菌素、左氧氟沙星、亚胺培南、头孢哌酮舒巴坦较敏感,对其他抗菌药物耐药率较高;革兰阳性球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因均敏感,对其余抗菌药物均有不同程度耐药。结论社区获得性肺炎病原体以革兰阴性杆菌为主,肺炎克雷伯菌感染率最高,革兰阳性球菌以金黄色葡萄球菌检出率最高,而且CAP患者病原体耐药情况严峻,在临床选择抗菌药物时要予以充分考虑。
Objective To understand the distribution and drug resistance of pathogenic bacteria in community-acquired pneumonia and provide basis for rational use of antibacterials in clinic. Methods The sputum culture results, serological test results and drug susceptibility test results of 558 CAP patients from TEDA Hospital in Tianjin from October 2013 to October 2015 were retrospectively analyzed. Results The etiological tests of 343 patients were positive, accounting for 61.47% of all patients, of which 228 were Gram-negative bacteria, accounting for 66.47%. Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bowman Acinetobacter, accounting for 25.36%, 13.99%, 7.58% and 6.12% respectively; Gram-positive bacteria 72, accounting for 20.99%, Staphylococcus aureus and Staphylococcus epidermidis accounting for 7.58%, 5.25 %; Fungi detected in 6 cases, accounting for 1.75%; serological test results in 37 cases, of which Mycoplasma pneumoniae accounted for 5.83%, 4.96% of Chlamydia pneumoniae; Gram-negative bacilli on the third and fourth generation cephalosporins, levofloxacin , Imipenem and cefoperazone sulbactam were more sensitive to other antibacterials. Gram positive cocci were sensitive to vancomycin, linezolid, tigecycline and nitrofurantoin, Drugs have varying degrees of resistance. Conclusions Gram-negative bacilli are the main pathogens of community-acquired pneumonia. Klebsiella pneumoniae has the highest infection rate, Gram-positive cocci has the highest detection rate of Staphylococcus aureus, and pathogen resistance of CAP patients is severe. In the clinical choice of antibacterial Medication should be fully considered.