【摘要】：目的了解下呼吸道感染患者病原菌的構(gòu)成、對藥物敏感度及耐藥性情況,總結(jié)經(jīng)驗(yàn)性抗生素使用效果,指導(dǎo)臨床對下呼吸道感染患者正確進(jìn)行經(jīng)驗(yàn)性抗生素治療,減少耐藥菌發(fā)生。根據(jù)藥敏結(jié)果合理應(yīng)用抗生素,減少ICU病房細(xì)菌耐藥的發(fā)生。 對象與方法本研究通過對咸水沽醫(yī)院(二級甲等醫(yī)院)2010年3月-2013年3月1312例下呼吸道感染患者的痰液標(biāo)本進(jìn)行痰培養(yǎng)細(xì)菌敏感性及耐藥性結(jié)果進(jìn)行回顧性分析,記錄、統(tǒng)計(jì)檢驗(yàn)結(jié)果。分析社區(qū)獲得性肺炎、醫(yī)院獲得性肺炎患者痰培養(yǎng)結(jié)果,對痰培養(yǎng)出細(xì)菌的藥物敏感性及耐藥性進(jìn)行分析,回顧性分析經(jīng)驗(yàn)性抗生素使用的規(guī)范性。 結(jié)果1312例下呼吸道感染患者中1086例行痰涂片及痰培養(yǎng)檢查,送檢率82.8%。送檢的1086例中痰涂片結(jié)果為革蘭氏陽性菌450例,占41.4%；革蘭氏陰性菌628例,占57.8%；酵母樣菌50例(其中42例為合并其它細(xì)菌感染),占4.6%。痰培養(yǎng)結(jié)果中,500例無致病菌生長,占46.1%；痰液標(biāo)本共分離病原菌586株,其中革蘭陽性菌12株,占2.0%,革蘭氏陰性菌574株,占98%,真菌50株,占4.6%。革蘭陰性菌對氨芐西林、頭孢唑林、阿莫西林/棒酸、復(fù)方磺胺甲基異惡唑的耐藥性較高,對氨芐西林耐藥率為44.1%,對頭孢唑林耐藥率為28.6%,對復(fù)方磺胺甲基異惡唑耐藥率為28.4%,對阿莫西林/棒酸耐藥率20.9%。社區(qū)獲得性肺炎痰涂片以革蘭氏陰性菌為主,部分痰培養(yǎng)無致病菌生長(與本院檢驗(yàn)科痰培養(yǎng)儀器及方法條件有限有關(guān))；醫(yī)院內(nèi)獲得性肺炎痰涂片以革蘭氏陰性菌為主,痰培養(yǎng)主要為肺炎克雷伯菌、陰溝腸桿菌和不動(dòng)桿菌屬為主,尤其ICU內(nèi)以銅綠假單胞菌和鮑曼不動(dòng)桿菌為主,且對所選抗生素耐藥性較高,并呈現(xiàn)多重耐藥性。真菌以白色念珠菌為主,對抗真菌藥物普遍敏感。抗生素使用方面,普通病房經(jīng)驗(yàn)性用藥以第二代頭孢菌素及青霉素/β-內(nèi)酰胺酶抑制劑為主,ICU中輕癥患者與普通病房抗生素使用基本相同,重癥、機(jī)械通氣支持呼吸及免疫力功能低下的患者以美洛培南為主,合并真菌者以伏立康唑?yàn)橹鳌?結(jié)論下呼吸道感染患者的病原菌種類較多,基層醫(yī)院條件有限,痰培養(yǎng)對臨床指導(dǎo)沒有達(dá)到應(yīng)有的水平。本組設(shè)計(jì)表現(xiàn)出社區(qū)獲得性肺炎中革蘭氏陽性菌為主,醫(yī)院獲得性肺炎以革蘭陰性菌感染占大多數(shù),ICU中以銅綠假單胞菌和鮑曼不動(dòng)桿菌為主,耐藥率較高且表現(xiàn)為多重耐藥。經(jīng)驗(yàn)性抗生素使用合理有效,本院普通病房細(xì)菌耐藥率低,但I(xiàn)CU中細(xì)菌耐藥率較高。
[Abstract]:Objective to investigate the composition of pathogens, drug sensitivity and drug resistance in patients with lower respiratory tract infection, and to summarize the effect of empirical antibiotic use in order to guide clinical experience antibiotic therapy in patients with lower respiratory tract infection. Reduce the incidence of drug-resistant bacteria. According to the results of drug sensitivity, antibiotics were used rationally to reduce the incidence of bacterial resistance in ICU ward. Participants and methods the sputum samples of 1312 patients with lower respiratory tract infection from March 2010 to March 2013 were analyzed retrospectively and the results of bacterial susceptibility and drug resistance were recorded. Statistical test results. The results of sputum culture in patients with community acquired pneumonia and hospital acquired pneumonia were analyzed. The drug sensitivity and drug resistance of sputum culture bacteria were analyzed. Results sputum smear and sputum culture examination were performed in 1086 of 1312 patients with lower respiratory tract infection. The results of sputum smear of 1086 cases were gram-positive bacteria (41.4%), Gram-negative bacteria (628 cases, 57.8%), yeast-like bacteria (42 cases were complicated with other bacterial infections) (4.6%). 586 strains of pathogenic bacteria were isolated from sputum samples, of which 12 strains were Gram-positive bacteria, 574 strains were Gram-negative bacteria, 98 strains were Gram-negative bacteria, and 50 strains were fungi, accounting for 4.6%. Gram-negative bacteria showed higher resistance to ampicillin, cefazolin, amoxicillin / koronic acid and compound sulfamethoxazole. The resistance rates to ampicillin, cefazolin, sulfamethoxazole and amoxicillin were 44.1, 28.6, 28.4 and 20.9 respectively. The sputum smears of community-acquired pneumonia were mainly Gram-negative bacteria, and some sputum culture did not cause the growth of pathogenic bacteria (related to the limited equipment and methods of sputum culture in our laboratory), and the hospital acquired pneumonia sputum smears were mainly Gram-negative bacteria. Sputum culture mainly consisted of Klebsiella pneumoniae, Enterobacter cloacae and Acinetobacter, especially Pseudomonas aeruginosa and Acinetobacter baumannii in ICU. Fungi are mainly Candida albicans and are generally sensitive to antifungal drugs. In the use of antibiotics, the second generation cephalosporin and penicillin / 尾 -lactamase inhibitor were used empirically in the general ward. The patients with mild disease in ICU were basically the same as those in the general ward. Mechanical ventilation supports malopenem in patients with low respiratory and immune function, and voleconazole in patients with fungi. Conclusion there are many kinds of pathogenic bacteria in patients with lower respiratory tract infection, the condition of basic hospital is limited, and the sputum culture does not reach the proper level for clinical instruction. The design showed that Gram-positive bacteria were the main bacteria in community-acquired pneumonia. Gram-negative bacilli were the major pathogens in hospital acquired pneumonia. Pseudomonas aeruginosa and Acinetobacter baumannii were the major pathogens in ICU. The drug resistance rate was high and multidrug resistance was found. The use of empirical antibiotics was reasonable and effective, the rate of bacterial resistance was low in our hospital, but the rate of bacterial resistance in ICU was higher.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R563

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