摘要
目的 了解本地区近年来肺部感染病原菌的变化特点 ,为临床经验性治疗应用抗生素提供依据。方法对本院 1998年以来内科住院的肺部感染性疾病的痰菌培养资料进行调查 ,分析各年份的送检率、病原菌种、菌群变化特点及影响因素。结果 近 6年来 ,患者 4 195例 ,送痰菌培养 2 2 71例 ,送检率仅 5 4 .1% ,但逐年增高 ;痰培阳养性率 31.9% ,分离出致病菌 5 3种 2 2 36株 ;其中革兰阴性菌占优势 ,占总菌株的 6 5 .0 5 % ,前 3位菌种分别为肺炎克雷伯菌 (从 4 7.2 %下降至 39.8% )、铜绿假单胞菌 (从 12 .3%上升至 31.1% )、大肠埃希菌 ;革兰阳性菌平均 16 .6 0 % ,其中以金黄色葡萄球菌为主 ,并逐年大幅度上升 (从 1998年的 2 3.5 %上升至 2 0 0 3年的 5 2 .6 % ) ;近3年 ESBL s检出率分别为 2 9.5 %、2 2 .2 %、13.5 % ,逐年有所下降。结论 肺部感染性疾病的病原菌诊断重视程度有待提高 ,诊断方法仍以咯痰培养为主要手段 ,但要严格质控 ,把好痰菌培养的 4个环节 :采痰、送痰、选痰、检痰 ;临床医师对肺部感染性疾病患者均应首先予以痰菌培养 ,后根据本地区病原菌分布特点进行经验性用药 ,然后再根据痰培养结果调整抗生素 ,这一诊治程序应予提倡。
OBJECTIVE To understand the pathogen change characteristic of lung infection in local area recently and to provide the treatment basis of antibiotic application with clinic experience. METHODS Reviewed the phlegm cultivation documents within the patients ill with lung infection diseases hospitalized in Internal Medicine Department from 1998,to analyze the examination rate every year to indicate pathogen species and strains change characteristic and affect factors. RESULTS In recent 6 years,among total of 4 195 cases,phlegm of 2 271 cases was cultivated,the examination rate was 54.1% and it is enhanced every year;the positive rate of phlegm cultivation was 31.9%. A total of 53 species 2 236 pathogen strains were isolated;among them Gram-negative bacilli had great advantage,about 65.05%. The first 3 rank species were Klebsiella pneumoniae (from 47.2% down to 39.8%),Pseudomonas aerugionosa (from 12.3% up to 31.1%),and Escherichia coli;Gram-positive cocci were 16.6%,in average mainly were Staphylococcus increased rapidly(from 23.5% in 1998 up to 52.6% in 2003);In recent 3 years ESBLs-producing isolate rate was 29.5%,22.2%,13.5%,with declined tendency. CONCLUSIONS To diagnose pathogen of lung infection diseases we should pay attention,the diagnostic method is still rely on phlegm cultivation. We should strictly control the four steps of phlegm cultivation: to collect phlegm,to deliver,to select,and to inspect specimen;we should recommend physician first to choose phlegm cultivation before use medicine with his experience when treat lung infection diseases,then adjust antibiotic based on phlegm cultivation results.
出处
《中华医院感染学杂志》
CAS
CSCD
2004年第5期582-584,共3页
Chinese Journal of Nosocomiology
关键词
肺部感染性疾病
痰菌培养
病原菌
Lung infection diseases
Phlegm incubation
Pathogen
