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目的了解医院呼吸道感染病原菌的分布及耐药性,为临床合理用药提供依据。方法收集2012-2014年送检的29352例痰液和咽拭子标本,采用VITEK-2 Compact辅以K-B纸片法对病原菌进行鉴定和药敏试验,采用WHONET5.6进行分析。结果共分离出4668株病原菌,革兰阴性杆菌占72.1%,革兰阳性球菌占27.9%;检出率前5位的菌依次是铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和鲍曼不动杆菌。MRSA检出率为56.1%,产ESBLs的大肠埃希菌和肺炎克雷伯菌检出率为34.8%和15.1%。多重耐药鲍曼不动杆菌分离率为44.7%。铜绿假单胞菌和鲍曼不动杆菌对多粘菌素、阿米卡星的耐药率低;大肠埃希菌和肺炎克雷伯菌对亚胺培南和美洛培南100%敏感,对阿米卡星耐药率均<5%;未发现耐万古霉素和替考拉宁的金黄色葡萄球菌。MRSA对所有药物的耐药性均高于MSSA,其中5种药物的耐药率经分析差异有统计学意义(P<0.01)。结论医院呼吸道分离菌以革兰阴性杆菌为主,应重视对细菌的耐药性监测,以促进临床合理用药。
Objective To understand the distribution and drug resistance of pathogenic bacteria in respiratory tract in hospitals and provide the basis for clinical rational drug use. Methods Thirty-two (29352) sputum and throat swabs were collected from 2012 to 2014. VITEK-2 Compact and K-B disk method were used to identify the pathogen and drug susceptibility test. The data were analyzed by WHONET 5.6. Results A total of 4668 pathogens were isolated, of which Gram-negative bacilli accounted for 72.1% and Gram-positive cocci accounted for 27.9%. The top 5 bacteria were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae , Staphylococcus aureus and Acinetobacter baumannii. The detection rate of MRSA was 56.1%. The detection rates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae were 34.8% and 15.1% respectively. Acinetobacter baumannii multi-drug separation rate was 44.7%. Pseudomonas aeruginosa and Acinetobacter baumannii polymyxin and amikacin low resistance rate; Escherichia coli and Klebsiella pneumoniae to imipenem and meropenem 100% sensitive, Amikacin resistance rates were <5%; no vancomycin and teicoplanin resistant Staphylococcus aureus was found. The drug resistance of MRSA to all the drugs was higher than that of MSSA. The drug resistance rates of the five drugs were statistically significant (P <0.01). Conclusions Gram-negative bacilli are the main respiratory pathogens in the hospital, and bacterial resistance should be emphasized in order to promote rational drug use in clinic.