痰培养病原菌分布及耐药性调查

目的了解该院痰标本中分离的病原菌分布及耐药性。方法收集该院痰标本586例,进行常规微生物培养及药敏试验。超广谱β-内酰胺酶(ESBLs)的检测应用纸片扩散法初筛和标准纸片扩法散确认,MRS的检测用头孢西丁纸片法,药敏试验采用K-B法。结果痰培养阳性率为46.9%,其中革兰阳性球菌77株,占28%,革兰阴性杆菌198株,占72%。检出率最高的细菌依次为铜绿假单胞菌(14.9%)、大肠埃希菌(11.6%)、肺炎克雷伯菌(8.4%)、凝固酶阴性葡萄球菌(8.4%)、不动杆菌(7.3%)、肠杆菌属(5.5%)、金黄色葡萄球菌(2.5%)。引起肺部感染的革兰阴性杆菌对亚胺培南的耐药率最低,不动杆菌为5.3%,铜绿假单胞菌为24.4%。产ESBLs菌阳性率:大肠埃希菌为40.6%,肺炎克雷伯菌为47.8%,产与非产ESBLs菌株的耐药率比较,除庆大霉素对大肠埃希菌无统计学意义外,其他测试抗菌药物对大肠埃希菌和肺炎克雷伯菌的耐药率差异有统计学意义(P<0.01)。MRS的检出率:凝固酶阴性葡萄球菌为47.1%,金黄色葡萄球菌为57.1%。所有分离菌株对常用抗菌药物的耐药性检测结果显示抗菌药物的多重耐药现象严重。结论痰培养的病原菌以革兰阴性杆菌为主,革兰阴性杆菌对亚胺培南的耐药率最低;未发现万古霉素和替考拉宁耐药的葡萄球菌;病原菌多重耐药现象严重,因此耐药性监测对指导临床合理使用抗菌药物十分重要。

Distribution of Pathogens and Research of Drug Resistance on 586 Sputum Specimens

Objective To investigate the distribution and drug resistance of pathogens isolated from 586 sputum specimens in Taihe Hospital.Methods A total of 586 sputum specimens collected from Taihe Hospital underwent microorganism culture and antibacterial agent sensitivity test.Disc diffusion screening and K-B disc diffusion confirmatory method were applied to detect ESBLs.MRS was detected by cefoxitin disc diffusion test,and K-B test was used to judge their sensitivities to antibacterial agents.Results The positive rate of sputum culture was 46.9%.Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,Staphylococcus coagulase-negative,Acinetobacter,Enterobacter,and Staphylococcus aureus were 7 commonly detected bacteria,the detection rates were 14.9%,11.6%,8.4%,8.4%,7.3%,5.5%,and 2.5%,respectively.Gram-negative bacilli showed the lowest drug resistance to imipenem.The resistance rate in Acinetobacter and Pseudomonas aeruginosa was 5.3% and 22.4% respectively.The detection rates of ESBLs producing strains in Escherichia coli and Klebsiella pneumoniae were 40.6% and 47.8%.The drug resistance in ESBLs producing strains was higher than that of non-ESBLs producing strains except gentamicin to ESBLs producing strains in Escherichia coli.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to the other tested antibiotics showed statistically significant differences(P<0.01).The detection rates of MRS were 47.1% and 57.1% in Staphylococcus coagulase-negative and Staphylococcus aureus.All strains showed a serious multiple drug resistance to most antibacterial agents.Conclusions Gram-negative bacilli are the major pathogens in the sputum culture,and show a lower drug resistance to imipenem.No resistant strain to vancomycin and teicoplanin in Staphylococcus is found.Pathogens are highly multi-drug resistant to most antibacterial agents.Therefore monitoring drug resistance is very important for instructing clinical doctors to use antibiotics properly.