摘要
目的分析开胸手术后下呼吸道感染病原菌及其耐药性,为临床合理选用抗菌药物提供依据。方法对首都医科大学宣武医院、首都医科大学肺癌诊疗中心2006年1月1日至2009年12月31日行开胸手术后下呼吸道感染患者118例（男89例,女29例;平均年龄64.6岁）,留取下呼吸道病原菌标本,采用一次性无菌集痰器或纤维支气管镜防污染毛刷吸取气管分泌物,立即送检,标本在接种前行细胞学筛选。按常规方法进行细菌培养、鉴定,并行药物敏感试验。结果检出下呼吸道病原菌共201株,其中革兰氏阴性杆菌126株（62.7%）,革兰氏阳性球菌66株（32.8%）,真菌9株（4.5%）。2006~2009年间分离率排在前4位的革兰氏阴性杆菌依次为不动杆菌34株（27.0%）,铜绿假单胞菌28株（22.2%）,克雷伯菌属19株（15.1%）和大肠埃希菌19株（15.1%）;2006~2008年间分离率排在第1位的革兰阴性杆菌是铜绿假单胞菌,但在2009年分离出不动杆菌9株（40.9%）,跃居第1位。2006~2009年间革兰氏阳性球菌主要是金黄色葡萄球菌35株（53%）;革兰氏阴性杆菌对亚胺培南最为敏感,革兰氏阳性球菌对万古霉素无耐药。结论开胸手术后下呼吸道感染病原菌革兰氏阴性杆菌多见,且耐药率高;加强病原菌耐药监测,有助于合理应用抗菌药物,有效控制感染。
Objective To study the distribution and drug-resistance of pathogens isolated from patients who suffered from lower respiratory infections after thoracotomy and provide basis for rational use of antibiotics in clinical practice.Methods A total of 118 patients suffered from lower respiratory infections after thoracotomy in Beijing Lung Cancer Center and the Thoracic Surgery Department of Xuanwu Hospital between January 1,2006 and December 31,2009.We performed a retrospective study on pathogens from their lower respiratory tract.Of these patients,89 are male and 29 are female with a mean age of 64.6 years.Sputum specimens were obtained by sterile sputum collectors or bronchofibroscopes,and then were sent to microorganism laboratory immediately.Cytological screening was carried out before specimen inoculation.Bacterial culture,identification and drug sensitivity test were performed with routine methods.Results A total of 201 strains of pathogens from the lower respiratory tract were identified.There were 126（62.7%） strains of gramnegative bacilli,66（32.8%） strains of gram-positive cocci,and 9（4.5%） strains fungi.The four prevalent gram-negative bacilli strains with the highest isolating rate between 2006 and 2009 included 34（27.0%） strains of acinetobacters,28（22.2%） strains of verdigris Pseudomonas,19（15.1%） strains of Klebsiellas and 19（15.1%） strains of Escherichia coli.Verdigris Pseudomonas ranked first in isolating rate among prevalent gram-negative bacilli strains from 2006 to 2008,but it was replaced by acinetobacters（9 strains,40.9%） in 2009.The most prevalent strains of gram-positive cocci were staphylococcus aureus（35 strains,53%） from 2006 to 2009.Gram-negative bacilli were most sensitive to imipenem and no gram-positive cocci were resistant to vancomycin.Conclusion Gram-negative bacilli are the most common pathogens in lower respiratory infections after thoracotomy and show extremely high drug-resistance rate.Drug-resistance monitoring of pathogens should be promoted.It may contribute to rational antimicrobial therapy and effective control of infections.
出处
《中国胸心血管外科临床杂志》
CAS
2011年第2期126-129,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
细菌
病原菌
耐药
开胸手术
Bacteria
Pathogen
Resistance
Thoracotomy
