目的 探讨呼吸内科院内感染的病原菌分布情况,并分析抗菌药物预防使用的合理性,以期为临床防控院内感染及优化抗菌治疗策略提供参考.方法 回顾性分析本院呼吸内科收治的1 866例住院患者的病历资料,鉴定检出病原菌,对比合并肺部基础疾病和未合并肺部基础疾病患者的病原菌分布差异.对主要病原菌进行药物敏感性测试,并结合患者用药情况,评估抗菌药物使用的合理性.结果 1 866例呼吸内科住院患者中,175例并发院内感染,感染率9.38％.其中116例合并肺部基础疾病,包括慢阻肺、慢性支气管炎、支气管哮喘等.共检出病原菌175株,革兰阴性菌占58.29％,革兰阳性菌占40.57％,真菌占1.14％.革兰阴性菌102株,包括肺炎克雷伯菌26株,大肠埃希菌19株,铜绿假单胞菌17株,鲍曼不动杆菌13株,流感嗜血杆菌12株,阴沟肠杆菌9株,嗜麦芽窄食单胞菌6株;革兰阳性菌71株,包括肺炎链球菌42株,金黄色葡萄球菌17株,表皮葡萄球菌9株,溶血性链球菌3株;真菌2株,均为白色假丝酵母菌.合并与未合并肺部基础疾病患者的主要病原菌构成比差异统计学意义(P＜0.05).肺炎链球菌对红霉素、克林霉素、复方新诺明、四环素的耐药率较高,对青霉素、左氧氟沙星、莫西沙星的耐药率较低,未产生对万古霉素、利奈唑胺的耐药株.肺炎克雷伯菌对氨苄西林、庆大霉素、左氧氟沙星、环丙沙星的耐药率较高,对阿米卡星、亚胺培南的耐药率较低.175例院内感染患者中,未预防用药70例,单一预防用药78例,联合预防用药27例.给药时间:术前1 h以上12例,术前0.5～1 h 23例,术前0.5 h内30例,术中给药40例.1 691例未合并院内感染患者中,未预防用药396例,单一预防用药997例,联合预防用药298例.给药时间:术前1 h以上220例,术前0.5～1 h 325例,术前0.5 h内467例,术中给药283例.两组患者的抗菌药物使用情况对比差异显著(P＜0.05).结论 呼吸内科住院患者院内感染的发生与肺部基础疾病密切相关,病原菌分布存在一定特点.不同病原菌对抗菌药物的耐药性存在差异,其中肺炎链球菌对红霉素、克林霉素等耐药率较高,而肺炎克雷伯菌则对氨苄西林、庆大霉素等耐药.院内感染与抗菌药使用情况具有一定相关性,合理使用抗菌药物对预防院内感染具有重要意义.
Distribution of pathogenic bacteria in nosocomial infections in the department of respiratory medicine and analysis of the rationality of preventive use of antibacterial drugs
Objective The aim of this study was to explore the distribution of pathogenic bacteria in respiratory hospital infections and analyze the rationality of using antibiotics for prevention,in order to provide reference for clinical prevention and control of hospital infections and optimization of antibacterial treatment strategies.Methods A retrospective analysis was conducted on the medical records of 1 866 inpatients admitted to the department of respiratory medicine in our hospital.The detected pathogenic bacteria were classified and identified,and the distribution differences of pathogenic bacteria between patients with and without underlying pulmonary diseases were compared.Drug sensitivity tests were performed on the main isolated pathogenic bacteria,and combined with the medication situation of patients,the rationality of antibacterial drug use was evaluated.Results Among 1866 inpatients in the department of respiratory medicine,175 cases had nosocomial infections,with an infection rate of 9.38％.Among them,116 cases had underlying pulmonary diseases,including chronic obstructive pulmonary disease,chronic bronchitis,bronchial asthma,etc.A total of 175 strains of pathogenic bacteria were detected.Gram-negative bacteria accounted for 58.29％,Gram-positive bacteria accounted for 40.57％,and fungi accounted for 1.14％.There were 102 strains of Gram-negative bacteria,including 26 strains of Klebsiella pneumoniae,19 strains of Escherichia coli,17 strains of Pseudomonas aeruginosa,13 strains of Acinetobacter baumannii,12 strains of Haemophilus inflluenzae,9 strains of Enterobacter cloacae,and 6 strains of Stenotrophomonas maltophilia.There were 71 strains of Gram-positive bacteria,including 42 strains of Streptococcus pneumoniae,17 strains of Staphylococcus aureus,9 strains of Staphylococcus epidermidis,and 3 strains of Streptococcus hemolyticus.There were 2 strains of fungi,both of which were Candida albicans.Comparing the main pathogenic bacteria of patients with and without underlying pulmonary diseases,the difference in constituent ratio was statistically significant(P＜0.05).Streptococcus pneumoniae had a high resistance rate to erythromycin,clindamycin,cotrimoxazole,and tetracycline,and a low resistance rate to penicillin,levofloxacin,and moxifloxacin.No resistant strains to vancomycin and linezolid had been produced.K.pneumoniae had a high resistance rate to ampicillin,gentamicin,levofloxacin,and ciprofloxacin,and a low resistance rate to amikacin and imipenem.Among the 175 patients with nosocomial infections,70 cases did not receive prophylactic drugs,78 cases received single prophylactic drug,and 27 cases received combined prophylactic drugs.Administration time:12 cases were more than 1 hour before surgery,23 cases were 0.5-1 hour before surgery,30 cases were within 0.5 hour before surgery,and 40 cases were administered during surgery.Among 1691 patients without nosocomial infections,396 cases did not receive prophylactic drugs,997 cases received single prophylactic drug,and 298 cases received combined prophylactic drugs.Administration time:220 cases were more than 1 hour before surgery,325 cases were 0.5-1 hour before surgery,467 cases were within 0.5 hour before surgery,and 283 cases were administered during surgery.There was a significant difference in the use of antibacterial drugs between the two groups of patients(P＜0.05).Conclusion The occurrence of nosocomial infections in inpatients in the department of respiratory medicine was closely related to underlying pulmonary diseases,and there were certain characteristics in the distribution of pathogenic bacteria.Different pathogenic bacteria had different drug resistance to antibacterial drugs.Among them,S.pneumoniae had a high resistance rate to erythromycin,clindamycin,etc.,while K.pneumoniae was resistant to ampicillin,gentamicin,etc.Nosocomial infections had a certain correlation with the use of antibacterial drugs.Reasonable use of antibacterial drugs was of great significance for preventing nosocomial infections.
department of respiratory medicinenosocomial infectiondistribution of pathogenic bacteriaantibacterial drugs
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