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目的分析住院尘肺患者院内感染的病原学特点,为临床治疗提供依据。方法分析2004年11月至2006年4月住院治疗的尘肺患者病原菌感染及耐药情况。结果81例尘肺患者送检痰标本640份,分离出致病菌184株,检出率为28.75%,检出革兰阴性杆菌75株(40.76%),革兰阳性球菌59株(32.06%),真菌50株(27.18%);肺炎支原体感染24例,感染率为29.12%。结核检查痰涂片标本108份,均为阴性。肺炎克雷伯杆菌对氨苄西林、环丙沙星、氨曲南、头孢噻肟耐药率分别为96.55%、34.48%、82.75%、44.82%;大肠杆菌对氨苄西林、环丙沙星、氨曲南、头孢噻肟的耐药率分别为95.00%、45.00%、85.00%、55.00%,对哌拉西林或他唑巴坦、亚胺培南均敏感,耐药率低。耐甲氧西林的表皮葡萄球菌(MRSE)和耐甲氧西林的金黄色葡萄球菌(MRSA)对青霉素耐药率为88.46%和100.00%,对万古霉素均无耐药。Ⅲ期尘肺患者的肺炎支原体感染率明显高于Ⅰ期和Ⅱ期尘肺,差异有统计学意义(P<0.05);尘肺并发慢性阻塞性肺疾病患者的病原菌检出率明显高于单纯尘肺患者,差异有统计学意义(P<0.01)。结论尘肺患者的院内感染以革兰阴性杆菌为主,革兰阴性杆菌对氨苄西林、氨曲南、头孢噻肟不敏感,对亚胺培南、哌拉西林或他唑巴坦敏感。MRSE、MRSA对万古霉素无耐药。
Objective To analyze the etiological characteristics of nosocomial infections in patients with pneumoconiosis and provide basis for clinical treatment. Methods The pathogen infection and drug resistance of pneumoconiosis patients hospitalized from November 2004 to April 2006 were analyzed. Results A total of 640 sputum samples were collected from 81 patients with pneumoconiosis, 184 bacterial pathogens were isolated, the detection rate was 28.75%. 75 (40.76%) Gram-negative bacilli and 59 (32.06%) Gram- , 50 strains of fungi (27.18%); Mycoplasma pneumoniae infection in 24 cases, the infection rate was 29.12%. Tuberculosis sputum smear specimens 108, were negative. The antibiotic resistance rates of Klebsiella pneumoniae to ampicillin, ciprofloxacin, aztreonam and cefotaxime were 96.55%, 34.48%, 82.75% and 44.82%, respectively. The antibacterial activity of Escherichia coli against ampicillin, ciprofloxacin, The resistance rate of Quenan and Cefotaxime was 95.00%, 45.00%, 85.00% and 55.00%, respectively. All of them were sensitive to piperacillin or tazobactam and imipenem, with low resistance rate. Methicillin-resistant Staphylococcus epidermidis (MRSE) and methicillin-resistant Staphylococcus aureus (MRSA) showed penicillin resistance rates of 88.46% and 100.00%, respectively, with no resistance to vancomycin. The infection rate of Mycoplasma pneumoniae in stage Ⅲ patients with pneumoconiosis was significantly higher than that in stage Ⅰ and Ⅱ pneumoconiosis (P <0.05). The detection rate of pathogenic bacteria in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease was significantly higher than that in patients with pneumoconiosis alone. The difference was statistically significant (P <0.01). Conclusions Infection in patients with pneumoconiosis is Gram-negative bacilli. Gram-negative bacilli are not sensitive to ampicillin, aztreonam and cefotaxime, and sensitive to imipenem, piperacillin or tazobactam. MRSE, MRSA no resistance to vancomycin.