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目的了解池州市医院获得性肺炎(HAP)病原菌分布及主要致病菌流行特点。方法以2014年池州市人民医院医院获得性肺炎病例为研究对象。收集患者痰液标本,菌株鉴定采用VITEK2Compact全自动细菌鉴定仪。采用K-B纸片法检测主要病原菌对9种常见抗生素耐药情况。采用煮沸法提取鲍曼不动杆菌DNA,参照GenBank设计鲍曼不动杆菌主要致病基因引物,并进行聚合酶链反应(PCR扩增)。结果 56例患者痰液标本中分离出62株病原菌,其中鲍曼不动杆菌34株,肺炎克雷伯菌15株,耐甲氧西林金黄色葡萄球菌6株,铜绿假单胞菌5株,大肠埃希菌和嗜麦芽窄食单胞菌各1株。泛耐药鲍曼不动杆菌对氨卡西林、青霉素、庆大霉素、头孢噻吩和头孢他啶等抗生素100%耐药,对妥布霉素、左氧氟沙星、头孢吡肟、美罗培南和亚胺培南等抗生素的耐药率分别为97.06%、97.06%、94.12%、94.12%和85.29%。鲍曼不动杆菌耐药基因OXA-23、OXA-24、OXA-58、CTX-M-9、aac(3)-I、ant(3//)-I、aph(3/)-I、adeB的检出率分别为79.41%、17.65%、67.65%、44.12%、23.53%、17.65%、61.76%和91.18%。讨论鲍曼不动杆菌是HAP感染的主要致病菌。控制鲍曼不动杆菌的流行有利于医院获得性肺炎的防控。
Objective To investigate the distribution of pathogenic bacteria in hospital acquired pneumonia (HAP) and the prevalence of major pathogens in Chizhou city. Methods 2014 cases of acquired pneumonia in Chizhou People’s Hospital were studied. Sputum samples were collected and the strains were identified by VITEK2 Compact automatic analyzer. K-B disc method was used to detect the main pathogens of 9 kinds of common antibiotic resistance. The Acinetobacter baumannii DNA was extracted by boiling method. The main pathogenic genes of Acinetobacter baumannii were designed according to GenBank and subjected to polymerase chain reaction (PCR). Results Sixty-six pathogens were isolated from sputum specimens of 56 patients, including 34 strains of Acinetobacter baumannii, 15 strains of Klebsiella pneumoniae, 6 strains of methicillin-resistant Staphylococcus aureus, 5 strains of Pseudomonas aeruginosa, Escherichia coli and Stenotrophomonas maltophilia a strain. The pan-drug-resistant Acinetobacter baumannii is 100% resistant to amikacin, penicillin, gentamicin, cefalotin and ceftazidime, and has antibiotic resistance to tobramycin, levofloxacin, cefepime, meropenem and imipenem The resistance rates of other antibiotics were 97.06%, 97.06%, 94.12%, 94.12% and 85.29%, respectively. Acinetobacter baumannii resistance genes OXA-23, OXA-24, OXA-58, CTX-M-9, aac (3) -I, ant (3 //) The detection rates of adeB were 79.41%, 17.65%, 67.65%, 44.12%, 23.53%, 17.65%, 61.76% and 91.18%, respectively. Discussion Acinetobacter baumannii is the main pathogen of HAP infection. Control of the prevalence of Acinetobacter baumannii is conducive to the prevention and control of hospital-acquired pneumonia.