2014年—2017年单中心呼吸内科医院感染患者的病原菌分布及药敏分析
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摘要
目的了解呼吸内科医院感染患者的病原菌分布情况,为呼吸内科住院患者优化抗菌药物选择提供参考。方法收集2014年1月至2017年1月医院呼吸内科住院患者1827份送检标本的检测结果,对确诊医院感染患者的痰液、咽拭子、血液、尿液、粪便、分泌物、胸水、导管、腹水、心包积液标本进行病原菌检测,并进行药敏试验。结果 816例患者发生医院感染92例,医院感染率为11.27%。816例患者的1827份送检标本中,确诊医院感染患者标本436份,痰液、尿液、分泌物阳性率较高;436份阳性标本中共检出病原菌474株,其中革兰阴性菌313株(占66.03%),革兰阳性菌为30株(占6.33%),真菌131株(占27.64%)。氨苄西林对肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌3种菌株耐药率均较高,鲍氏不动杆菌耐药率达到100%;头孢噻吩对葡萄球菌属、链球菌属耐药率较高。结论呼吸内科住院患者常见感染部位为呼吸道,病原菌以革兰阴性细菌为主,且耐药率较高,需根据药敏试验结果合理选择抗菌药物。
Objective To identify the pattern of distribution of pathogens that cause nosocomial infection in hospitalized patients with respiratory diseases so as to better inform the patients and staff of respiratory medicine in selecting antibiotics. Methods The results of 1827 specimens for testing from patients of respiratory diseases hospitalized during the period from January 2014 to January 2017 were collected. The sputum, throat swab, blood, urine, feces, secretions, pleural effusion, catheters, ascites, and pericardial effusion specimens obtained from the patients diagnosed as cases of nosocomial infection were tested for pathogenic bacteria and drug susceptibility. Results 92 cases of nosocomial infection were found out of 816 hospitialized patients. The infection rate was 11.27%. Of the 1827 specimens from 816 patients, 436 specimens were diagnosed as cases of nosocomial infection and the positive rates of sputum, urine and secretion were of the highest. 474 strains of pathogens were detected in the 436 positive specimens, of which 313 were Gram-negative bacteria(66.03%), 30 Gram-positive bacteria(6.33%), and 131 fungi(27.64%). The resistance of ampicillin to Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii was the greatest. The resistance rate of Acinetobacter baumannii reached 100%. Cefotaxime has rate of resistance to Staphylococcus and Streptococcus. Conclusions The common infection site in respiratory patients of nosocomial infection is the respiratory tract. The pathogens are mainly Gram-negative bacteria. Their capacity of drug resistance rate is high. Selection of antibiotics shall be conducted in compliance with the results of drug susceptibility test.
Objective To identify the pattern of distribution of pathogens that cause nosocomial infection in hospitalized patients with respiratory diseases so as to better inform the patients and staff of respiratory medicine in selecting antibiotics. Methods The results of 1827 specimens for testing from patients of respiratory diseases hospitalized during the period from January 2014 to January 2017 were collected. The sputum, throat swab, blood, urine, feces, secretions, pleural effusion, catheters, ascites, and pericardial effusion specimens obtained from the patients diagnosed as cases of nosocomial infection were tested for pathogenic bacteria and drug susceptibility. Results 92 cases of nosocomial infection were found out of 816 hospitialized patients. The infection rate was 11.27%. Of the 1827 specimens from 816 patients, 436 specimens were diagnosed as cases of nosocomial infection and the positive rates of sputum, urine and secretion were of the highest. 474 strains of pathogens were detected in the 436 positive specimens, of which 313 were Gram-negative bacteria(66.03%), 30 Gram-positive bacteria(6.33%), and 131 fungi(27.64%). The resistance of ampicillin to Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii was the greatest. The resistance rate of Acinetobacter baumannii reached 100%. Cefotaxime has rate of resistance to Staphylococcus and Streptococcus. Conclusions The common infection site in respiratory patients of nosocomial infection is the respiratory tract. The pathogens are mainly Gram-negative bacteria. Their capacity of drug resistance rate is high. Selection of antibiotics shall be conducted in compliance with the results of drug susceptibility test.
引文
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[2] 任南,文细毛,吴安华.2014年全国医院感染横断面调查报告[J].中国感染控制杂志,2016,15(2):83-87.
[3] 黄巍.国有特大型企业综合性医院医院感染的调查研究[D].兰州:兰州大学,2014.
[4] 宋昱晨,赵美芳,王月花.呼吸内科下呼吸道感染患者常见病原菌分布与相关危险因素分析[J].中华医院感染学杂志,2015,25(9):1965-1967.
[5] 刘卫平,孙德俊,闫志刚,等.呼吸内科患者医院感染特点及危险因素分析[J].中华医院感染学杂志,2017,27(18):4127-4130,4135.
[6] 葛艳,鲁艳红,高文俊.呼吸内科患者医院感染的危险因素分析[J].中华医院感染学杂志,2014,24(11):2690-2692.
[7] 许建江,张斌,赵圣刚,等.心内科住院患者医院感染的病原菌分布及药敏分析[J].浙江医学,2017,39(22):1998-2001,2004.
[8] 蔡惠惠,王萍,赵水娣.大肠埃希菌和肺炎克雷伯菌耐药率及抗菌药使用分析[J].药物流行病学杂志,2018,27(4):239-243.
[9] 鄂顺梅,龙一飞,曾建明,等.亚抑菌浓度环丙沙星对大肠埃希菌喹诺酮类耐药质粒接合转移的影响[J].山东医药,2017,57(43):25-28.
[10] 张欠欠,宋静,党旭东,等.儿童真菌感染及耐药性分析[J].中国卫生检验杂志,2017,27(3):434-435,440.