1002例尘肺病患者下呼吸道感染病原菌分布及耐药性分析

目的 对尘肺病合并下呼吸道感染患者的痰培养结果及耐药现状进行统计分析,了解病原菌的耐药性,为临床医师合理、经验、有效地使用抗菌药物提供依据.方法 采用口痰培养法收集标本,应用Auto Scan 4自动微生物鉴定系统进行细菌鉴定及药敏试验,同时结合K-B纸片法.结果 共送检标本1002份,培养出病原菌249株,其中革兰阴性杆菌206株占82.7％,前3位分别为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌,分别占22.9％、12,9％、12.0％,革兰阳性球菌28株占11.2％,主要为表皮葡萄球菌、金黄色葡萄球菌,各占32.1％、21.4％,真菌15株占6.0％,主要为白色假丝酵母菌；革兰阴性杆菌对第二、三代头孢类抗菌药物体现耐药性较高,但对其复合酶制剂敏感性较好,对碳青霉烯类及第四代头孢类抗菌药物敏感性较好,其中铜绿假单胞菌耐药性最严重；革兰阳性球菌对第三、四代头孢菌素耐药率较高,对万古霉素高度敏感.结论 尘肺病患者下呼吸道感染的主要病原菌为革兰阴性杆菌,医师应监测细菌耐药性变化,合理使用抗菌药物.

Distribution of pathogens causing lower respiratory tract infections in pneumoconiosis patients and drug resistance

OBJECTIVE To statistically analyze the sputum culture for the pneumoconiosis patients with lower respiratory tract infections and the status of drug resistance,so as to provide bases for the reasonable,empirical and effective use of antibiotics.METHODS The bacteria were acquired from the sputum specimens and drug susceptibility testing was carried out by Auto Scan4 system and Kirby-Bauer method.RESULTS Of 1002 submitted specimens,there were 249 pathogens cultured,including 206(82.7%) strains of gram-negative bacilli,the top three were Klebsiella pneumonia,Escherichia coli,and Pseudomonas aeruginosa,accounting for 22.9%,12.9%,and 12.0%,respectively;there were 28(11.2%) strains of gram-positive cocci,mainly including Staphylococcus aureus(21.4%) and S.epidermidis(32.1%);there were 15(6.0%) strains of fungi,Candida albicans was the main species;the gram-negative bacilli were highly resistant to the second and third generation of cephalosporins,but remained highly susceptbile to the fourth generation of cephalosporins,carbapenem and vancomycin as well as the complex enzymes,the drug resistance of P.aeruginosa was serious;gram-positive cocci were highly resistant to the third and fourth generation of cephalosporins and highly susceptbile to vancomycin.CONCLUSION Gram-negative bacteria are the main pathogens causing lower respiratory tract infections in pneumoconiosis patients,it is necessary for the clinician to monitor the bacterial resistance and reasonably use antibiotics.