摘要
目的 分析近4年河北省三甲医院呼吸道感染致病菌变化及其特点,为临床诊治提供新的依据.方法 采用单中心回顾性分析方法,选择2013年1月至2016年12月在河北省胸科医院住院的呼吸道感染患者7497例.收集所有患者深部痰液、纤维支气管镜取痰及上呼吸道分泌物的细菌培养和药敏分析结果.结果 研究期间共入选呼吸道感染患者7497例,分离出优势致病菌13种、11909株,包括白色念珠菌（23.7%）、肺炎克雷伯菌（12.9%）、铜绿假单胞菌（11.6%）、大肠埃希菌（9.5%）、光滑念珠菌（9.1%）、鲍曼不动杆菌（7.9%）、曲霉菌（6.7%）、嗜麦芽窄食假单胞菌（4.5%）、凝固酶阴性葡萄球菌（3.7%）、其他假单胞菌种（3.7%）、金黄色葡萄球菌（3.0%）、阴沟肠杆菌（1.9%）、热带念珠菌（1.8%）.优势革兰阴性（G^-）菌共7种、6198株,占全部菌种的52.0%,以肺炎克雷伯菌（24.8%）、铜绿假单胞菌（22.3%）、大肠埃希菌（18.2%）、鲍曼不动杆菌（15.3%）为主,并逐年递增;药敏分析结果显示,优势G^-菌的抗菌药物首选碳青霉烯类,其次为头胞哌酮舒巴坦、头胞吡肟、阿米卡星、三代头孢菌素等.优势革兰阳性（G^＋）菌共2种、798株,占全部菌种的6.7%,分别为凝固酶阴性葡萄球菌（54.8%）和金黄色葡萄球菌（45.2%）,各年份变化不大;药敏结果显示,优势G^＋菌对糖肽类敏感,其次为头胞西丁、复方新诺明、四环素类、喹诺酮类、阿奇霉素、红霉素等.优势真菌4种、4913株,占全部菌种的41.3%,以白色念珠菌为主（57.5%）,且呈逐年递增趋势;药敏结果显示,优势真菌对抗真菌药物敏感率均较高.结论 G^-菌仍为呼吸道感染患者的主要感染源,并呈逐年升高趋势;真菌感染也不容忽视,应重视其诱因,并加强抗菌药物的合理使用.
Objective To analyze the changes and characteristics of respiratory tract bacteria in Hebei 3A Hospital, and to provide new rationale for clinical diagnosis and treatment.Methods A single-center retrospective analysis was conducted. 7497 patients with respiratory tract infection admitted to Hebei Chest Hospital from January 2013 to December 2016 were enrolled. Deep sputum was collected, and the bacterial cultures and susceptibility analysis was conducted in sputum and upper respiratory secretions were collected by fiberoptic bronchoscopy.Results A total of 7497 patients with respiratory tract infection were enrolled in the study, and 11909 strains of 13 kinds of dominant pathogens were isolated. The dominant pathogens for respiratory tract infection wereMonilia albican （23.7%）,Klebsiella pneumoniae （12.9%）,Pseudomonas aeruginosa （11.6%）,Escherichia coli （9.5%）,Candida glabrata （9.1%）,Acinetobacter baumanii （7.9%）,Aspergillus （6.7%）,Stenotrophomonas maltophilia （4.5%）, coagulase negativeStaphylococcus（3.7%） and some species ofPseudomonas （3.7%）,Staphylococcus aureus （3.0%）,Aerobacter cloacae （1.9%）, andCandida tropicalis （1.8%）. A total of 6198 strains of 7 kinds of Gram negative （G^-） bacilli infection dominant pathogens accounts for 52.0% of all infections,Klebsiella pneumonia （24.8%）,Pseudomonas aeruginosa （22.3%）,Escherichia coli （18.2%） andAcinetobacter baumanii （15.3%） were the main pathogens, and increased year by year. Susceptibility analysis showed that the preferred antibiotics for G^- bacteria were carbapenems, followed by risperidone, sulbactam, cefepime, amikacin, and the third generation of cephalosporins. A total of 798 strains of 2 kinds of Gram positive （G^＋） bacilli infection dominant pathogens accounted for 6.7% of all infections, were coagulase negativeStaphylococcus（54.8%） and Staphylococcus aureus （45.2%）, each had changed little by year. Susceptibility analysis showed that G^＋ bacteria were sensitive to glycopeptides, followed by cefoxitin, cotrimoxazole, the tetracyclines, quinolones, azithromycin, erythromycin and so on. The advantages of 4 species of fungi were 4913 strains, accounted for all of the 41.3% strains, with 57.5% of Candida albicans, and the trend was increasing year by year. Susceptibility analysis results showed that the antifungal susceptibility of dominant fungi were higher.Conclusions G^- bacilli is still the main source of infection, and showed an upward trend year by year. Fungal infection rate cannot be ignored, and we must pay attention to fungal infection incentives. We should strengthen the rational use of antibiotics.
作者
侯莉莉
刘莉丽
党萍
康冠楠
张勤风
李东玲
Hou Lili Liu Lili Dang Ping Kang Guannan Zhang Qinfeng Li Dongling(Department of Internal Medicine, Hebei Chest Hospital, Shijiazhuang 050041, Hebei, China Department of Image, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, Chin)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第9期799-804,共6页
Chinese Critical Care Medicine
基金
河北省临床重点专科建设项目（2017-7）
关键词
呼吸道感染
菌种分布
抗菌药物
Respiratory tract infection
Pathogenic distribution
Antibiotics
