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目的研究煤矿工作者尘肺合并下呼吸道感染患者病原菌分布及耐药情况,为临床科学选用抗菌药物提供参考依据。方法采用病原菌分离鉴定技术和药敏试验方法,对某医院住院煤工尘肺者合并呼吸道感染病原菌进行检测与分析。结果共检测住院煤工尘肺患者送检标本1 300份,检出病原菌638株,检出率为49.08%。检出的病原菌中,革兰阴性杆菌占60.0%,革兰阳性球菌占6.58%,真菌占33.39%。排列前5位的优势菌依次为肺炎克雷伯菌、念珠菌、白假丝酵母菌、铜绿假单胞菌和产酸克雷伯菌。革兰阴性杆菌对青霉素类、头孢类、磺胺类和呋喃类抗菌药物耐药较严重,仅对碳青霉烯类和氨基糖甙类敏感。革兰阳性球菌普遍耐药,但未发现耐万古霉素菌株。结论革兰阴性杆菌为本地区煤工尘肺合并下呼吸道感染的主要病原菌,其常用抗菌药物耐药现状严重,临床医师应根据细菌耐药性变化趋势,合理选择应用抗菌药物。
Objective To study the distribution and drug resistance of pathogens in coal mine workers with pneumoconiosis and lower respiratory tract infection and to provide a reference for the selection of antibacterial drugs in clinical science. Methods Pathogenic bacteria isolation and identification techniques and susceptibility testing methods were used to detect and analyze the pathogenic bacteria of respiratory tract infection in hospitalized coal workers with pneumoconiosis. Results A total of 1 300 samples of coal workers’ pneumoconiosis were detected and 638 strains of pathogens were detected. The detection rate was 49.08%. Among the pathogenic bacteria detected, Gram-negative bacilli accounted for 60.0%, Gram-positive cocci accounted for 6.58% and fungi accounted for 33.39%. The predominant bacteria ranked in the top five were Klebsiella pneumoniae, Candida albicans, Candida albicans, Pseudomonas aeruginosa and Klebsiella oxytoca. Gram-negative bacilli are more resistant to penicillins, cephalosporins, sulfonamides and furans and are only susceptible to carbapenems and aminoglycosides. Gram-positive cocci were generally resistant, but no vancomycin-resistant strains were found. Conclusions Gram-negative bacilli are the main pathogenic bacteria in coal miners pneumoconiosis with lower respiratory tract infection in this area. The prevalence of commonly used antimicrobial resistance is serious. Clinicians should choose antibiotics reasonably according to the trend of bacterial resistance.