摘要
目的:了解我院急诊病房收治的下呼吸道感染患者的病原菌及耐药状况。方法:回顾性分析2015-01—2018-12期间我院急诊病房收治的316例下呼吸道感染患者,痰、血、尿、创面分泌物、中心静脉导管等标本培养的591株细菌及药敏状况。结果:①细菌谱以革兰氏阴性菌为主(65.65%),其次是革兰氏阳性菌(24.70%)和念珠菌(热带假丝酵母菌、白色假丝酵母菌、光滑念珠菌和近平滑假丝酵母菌)(9.65%)。②痰标本培养细菌主要有鲍曼不动杆菌106株、铜绿假单胞菌67株、MRSA65株、肺炎克雷伯菌34株和嗜麦芽窄食单胞菌22株;血标本培养细菌主要有大肠埃希菌31株、肺炎克雷伯菌4株、屎肠球菌3株、鲍曼不动杆菌2株、铜绿假单胞菌2株、MRSA2株和奇异变形杆菌2株;尿标本培养细菌主要有热带假丝酵母菌23株、大肠埃希菌22株、白色假丝酵母菌17株、屎肠球菌12株和铜绿假单胞菌10株;创面分泌物标本细菌培养主要有奇异变形杆菌6株、铜绿假单胞菌4株、大肠埃希菌4株、鲍曼不动杆菌3株和粪肠球菌3株;中心静脉导管标本细菌培养仅有洋葱伯克霍尔德菌1株。③24例住院日超过30 d病例痰、血、尿、创面分泌物等标本培养细菌83株,其中革兰氏阳性菌20株,革兰氏阴性菌53株,念珠菌(热带假丝酵母菌、白色假丝酵母菌、光滑念珠菌和近平滑假丝酵母菌)10株;63例死亡病例痰、血、尿、创面分泌物等标本培养细菌131株,其中革兰氏阳性菌30株,革兰氏阴性菌89株,念珠菌(热带假丝酵母菌、白色假丝酵母菌、光滑念珠菌)12株;44例使用有创呼吸机病例痰标本培养细菌93株,其中革兰氏阳性菌19株,革兰氏阴性菌73株,白色假丝酵母菌1株。④主要革兰氏阴性菌中鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌等对亚胺培南、美罗培南、头孢他啶、头孢吡肟、头孢哌酮/舒巴坦、环丙沙星、左氧氟沙星耐药率较高;主要革兰氏阳性菌中MRSA、屎肠球菌、粪肠球菌均未见万古霉素、替考拉宁、利奈唑胺耐药株。结论:急诊病房下呼吸道感染患者的病原菌以革兰氏阴性菌为主,多重耐药菌占比高。临床医师应注意重点分析痰标本培养的细菌是定植菌还是致病菌,规范抗菌药物使用,加强耐药监测。
Objective: To investigate the bacterial and drug resistance of patients with lower respiratory tract infection in emergency ward of our hospital. Method: From January 2015 to December 2018, 591 strains of bacteria and drug sensitivity were analyzed in 316 patients with lower respiratory tract infection, including sputum, blood, urine, wound secretions and central venous catheters. Result: ①The bacterial spectrum was dominated by Gram-negative bacteria(65.65%), followed by Gram-positive bacteria(24.70%) and Candida(Candida tropicalis, Candida albicans, Candida glabrata and Candida smoothness)(9.65%). ②The sputum specimens were mainly composed of 106 strains of Acinetobacter Bauman, 67 strains of Pseudomonas aeruginosa, 65 strains of MRSA, 34 strains of Klebsiella pneumoniae and 22 strains of Stenotrophomonas maltophilia. The blood specimens were mainly composed of 31 strains of Escherichia coli, 4 strains of Klebsiella pneumoniae, 3 strains of Enterococcus faecium, 2 strains of Acinetobacter, 2 strains of Pseudomonas aeruginosa, 2 strains of MRSA and 2 strains of Proteus mirabilis. The main bacteria in urine culture were 23 strains of Candida tropicalis, 22 strains of Escherichia coli, 17 strains of Candida albicans, 12 strains of Enterococcus faecium and 10 strains of Pseudomonas aeruginosa. The wound secretions specimens were 6 strains of Proteus mirabilis, 4 strains of Pseudomonas aeruginosa, 4 strains of Escherichia coli, 3 strains of Acinetobacter and 3 strains of Enterococcus faecalis. 1 strain of Burkholderia onions was cultured in central venous catheter specimens. ③83 strains of bacteria were detected in sputum, blood, urine and wound secretions of 24 patients with hospitalization for more than 30 days, including 20 strains of Gram-positive bacteria, 53 strains of Gram-negative bacteria and 10 strains of candida. 131 strains of bacteria were detected in sputum, blood, urine and wound secretions of 63 dead cases, including 30 strains of Gram-positive bacteria, 89 strains of Gram-negative bacteria and 12 strains of candida. 93 strains of bacteria were detected in sputum specimens of 44 cases with invasive ventilator, including 19 strains of Gram-positive bacteria, 73 strains of Gram-negative bacteria and 1 strain of Candida albicans. ④Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae were resistant to imipenem, meropenem, ceftazidime, cefepxime, cefoperazone/sulbactam, ciprofloxacin and levofloxacin in the main Gram-negative bacteria. No vancomycin, teicoplanin and linazolamine resistant strains were found in MRSA, Enterococcus faecium and Enterococcus faecalis in the main Gram-positive bacteria. Conclusion: Gram-negative bacteria were the main pathogens in patients with lower respiratory tract infection in emergency ward, and multi-drug resistant bacteria accounted for a high proportion. Clinicians should pay more attention to analyzing whether bacteria cultured in sputum specimens were colonized bacteria or pathogenic bacteria, standardizing the use and treatment of antibiotics, and strengthening drug resistance monitoring.
作者
刘剑烽
LIU Jianfeng(Department of Emergency,Guangzhou Red Cross Hospital,Jinan University,Guangzhou,510220,China)
出处
《临床急诊杂志》
CAS
2020年第2期125-134,共10页
Journal of Clinical Emergency
关键词
急诊病房
下呼吸道感染
细菌
耐药性
emergency ward
lower respiratory infection
bacteria
tolerance
作者简介
通信作者:刘剑烽,E-mail:ljf0809@163.com
