潮州地区下呼吸道感染病原菌分布、耐药性监测及临床用药分析

目的：研究潮州地区下呼吸道感染病原菌的分布及进行耐药监测,同时了解抗菌药物使用情况。方法：选择2012年1月~2014年6月2 368例我院呼吸内科下呼吸道感染患者痰液进行细菌培养、菌种鉴定及药敏试验,统计分析病原菌耐药性,分析抗菌药物使用情况。结果：2368例患者检出1108株病原菌,分离率46.8%（1108/2368）。其中检出细菌1001例（占90.3%）,真菌107例（占9.7%）。病原菌主要以革兰阴性菌为主,前五位依次为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、流感嗜血杆菌、大肠埃希菌;分离的革兰阳性菌主要以金黄色葡萄球菌为主,其次肺炎链球菌;分离出的真菌主要以白色假丝酵母菌为主,占真菌82.2%（88/107）。本研究分离的肺炎克雷伯菌和大肠埃希菌产ESBLs株分离率分别为43.0%（83/193）及72.8%（43/59）,非产ESBLS株对常用抗生素的耐药率均低于产ESBLS株,未发现对亚胺培南、美罗培南耐药的菌株。铜绿假单胞菌对哌拉西林/他唑巴坦、阿米卡星、妥布霉素、左氧氟沙星的耐药率均低于20%,对亚胺培南和美罗培南的耐药率分别为17.3%和16.8%;鲍曼不动杆菌对亚胺培南和美罗培南的耐药率均为68.1%（94/138）,多重耐药的鲍曼不动杆菌对常用抗菌药物的耐药率除多黏菌素外均大于90%。检出1108株病原菌中病例有756例,其中528例根据药敏结果调整用药,有效例数493例,有效率93.37%（493/528）。结论：下呼吸道感染细菌以革兰阴性菌为主,多种细菌对临床常用抗菌药物存在不同程度的耐药,有条件的医院应及早进行痰培养、药敏试验,及早调整抗菌药物,提高了临床治疗有效率。

Surveillance of Pathogens and bacterial resistance of lower respiratory tract infections in Chaozhou and the analyzing of clinical medication

Objective：To investigate the Pathogens and the antibiotic resistance of lower respiratory tract infections in Chaozhou. Looking into the using of clinical antibiotics, then to provide Reference to the treatment. Methods：Bacteria were tested using sputum culture of 2368 patients hospitalized in Respiratory department of Chaozhou Center Hospital from 2012. 01 to 2014. 06. A retrospective study was carried out using whonet 5. 6 software to analyze antibiotic resistance of Pathogens and the using of the Antibacterial drugs. Results： 1108 Pathogenic bacterias were detected from 2368 patients, The detection rate was 46.8%（1108/2368）. Among then,1001 cases were Bacteria（90.3%）, 107 cases were Fungi（9.7%）. The main Pathogens were gram-negative bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Haemophilus influenzae, Escherichia coli befor five Sequential. Most gram-positive bacterias were Staphylococcus aureus, small part were Streptococcus pneumoniae. The main detected Fungi were Candida albicans, taking 82. 2＆amp;nbsp;Percentage（88/107）. The results showed that ESBLs produced Klebsiella pneumoniae and Escherichia coli were 43.0% （83/193） and 72.8%（43/59）. The Resistance rates of Non- ESBLs produced Baterias were lower than the ESBLs produced Baterias. There were no imipenem and meropenem resistant isolates. The drug resistant rates of Pseudomonas aeruginosa to Piperacillin / tazobactam, Amikacin, Tobramycin, Levofloxacin were all lower than 20%. Drug resistant rates of Pseudomonas aeruginosa to imipenem and meropenem were 17.3% and 16.8%. The drug resistant rates of Acinetobacter baumannii to imipenem and meropenem were both 68.1%. Drug resistant rate of Multi-drug resistant Acinetobacter baumannii to common Antibiotics was over 90% except Polymyxin. 1108 isolates were brought up from 756 patients. Among then, 528 patients changed the antibiotics according to the susceptibility and 493 patients had effects. The efficient rate was 93.37（493/528?