标题：1 263例下呼吸道感染患者的病原菌分布及耐药性分析

      作者：曾永保 1，尹春梅 2，李 雯 1，范世明 3，王丽琴 4
    (宜宾市第一人民医院药剂科 1、普外科 2、呼吸内科 3、检验科 4，四川 宜宾 644000)

      卷次： 2014年25卷22期

      【摘要】 目的 了解我院下呼吸道感染患者的病原菌分布及其耐药情况，为临床合理选用抗菌药物提供用
药参考。方法 回顾性分析1 263例下呼吸道感染患者的病原菌分布及其耐药性。结果 1 263例痰标本共分
离出病原菌453例，其中革兰氏阴性菌(G-) 317例(70.0%)，革兰氏阳性菌(G+) 91例(20.1%)，真菌45例(9.9%)。位
列前6位的病原菌依次为肺炎克雷伯菌、流感嗜血杆菌、肺炎链球菌、大肠埃希菌、铜绿假单胞菌和金黄色葡萄球
菌。药敏结果显示G-对亚胺培南，头孢吡肟耐药率最低，其次为哌拉西林他唑巴坦、头孢哌酮舒巴坦、头孢他啶、
头孢唑肟等；G+对去甲万古霉素耐药率最低，其次为头孢唑林、头孢拉定、头孢呋辛、苯唑西林等；真菌对氟康唑、
两性霉素B等均较为敏感。结论 我院下呼吸道感染病原菌以G-为主，其次是G+、真菌。经验治疗可选择头孢
三代，哌拉西林他唑巴坦，苯唑西林等抗菌药物。多重耐药菌可根据药敏结果选择头孢四代、亚胺培南、去甲万
古霉素等治疗或联合用药。

      【关键词】 下呼吸道感染；抗菌药物；病原菌；耐药性；药敏

      【中图分类号】 R56 【文献标识码】 A 【文章编号】 1003—6350（2014）22—3336—04


Analysis of pathogens distribution and drug resistance in 1 263 lower respiratory tract infections cases.
ZENG
Yong-bao 1, YIN Chun-mei 2, LI Wen 1, FAN Shi-ming 3, WANG Li-qin 4. Department of Pharmacy 1, General Surgery 2,
Respiratory Medicine 3, Clinical Laboratory 4, the First Hospital of Yibin, Yibin 644000, Sichuan, CHINA

【Abstract】 Objective To analyze the pathogens distribution and drug resistance in patients with lower re-
spiratory tract-infections in the hospital so as to provide appropriate clinical treatment. Methods By retrospective
analysis of 1 263 cases of pathogens distribution and drug resistance in patients with lower respiratory tract infec-
tions. Results There were 453 cases with pathogenic bacteria in the sputum specimens. Among them there were
317 Gram-negative bacteria (G-) cases (accounting for 70.0%), 91 Gram-positive bacteria (G+) cases (20.1%), and 45
fungus cases (9.9%). The top six of pathogens were Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneu-
moniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. The results of drug susceptibility test
showed that G- were most sensitive to imipenem, cefepime, followed by piperacillin tazobactam, cefoperazone sulbac-
tam, ceftazidime, and ceftizoxime; G+ were most sensitive to norvancomycin, cefazolin, cephradine, cefuroxime, and
oxacillin; while fungi were sensitive to both fluconazole and amphotericin B. Conclusion In all the pathogens of
lower respiratory tract infection, G- was in the majority, followed by G + and the fungi. Therefore, third generation
cephalosporin, piperacillin-tazobactam and oxacillin can be adopted in the empiric treatment. While with multiple re-
sistant bacteria, fourth generations cephalosporin, imipenem, norvancomycin, or combination of drugs can be consid-
ered according to the susceptibility results.

      【Key words】 Lower respiratory tract infection; Antimicrobial agents; Pathogenic bacterium; Drug resistance;
Drug susceptibility