社区糖尿病人合并肺部感染病原菌的临床分析

摘要

目的 综合分析滨海新区社区糖尿病人合并肺部感染的病原菌,探寻基层医院治疗感染过程中的薄弱环节,提出有价值的参考依据.方法 回顾2011年10月至2014年10月收住本院内科系统合并肺部感染糖尿病人的痰液标本,利用统计学方法获得病原菌分布及耐药性情况.结果 共分离出病原菌582例.其中革兰阴性菌335例(肺炎克雷伯菌125例,大肠埃希菌83例);革兰阳性菌151例(金黄色葡萄球菌107例);真菌55例,均为白色念珠菌.肺炎克雷伯菌对氨苄西林敏感率为0,大肠埃希菌对头孢噻肟、头孢他啶的敏感率均低于63.00％,铜绿假单胞菌和鲍曼不动杆菌对氨苄西林/舒巴坦的敏感率分别为0、61.14％;金黄色葡萄球菌和凝固酶阴性葡萄球菌对苯唑西林的敏感率分别76.29％、57.14％.结论 滨海新区社区糖尿病人合并肺部感染的病原菌分布集中,种类相对单一,耐药性可控,分析原因可能与基层医院诊疗设施差,护理人员取材不规范,医师经验用药等有关.建议完善薄弱环节,加强医患沟通,合理应用性价比高的抗菌药物,减轻患者经济负担.%Objective To comprehensively analyze pathogenic bacteria in diabetes patients with pulmonary infection in the community of Binhai New Area,explore the weak link in the course of infection treatment in primary hospital,and put forward some valuable references.Methods Retrospectively analyzed sputum specimens of diabetes patients with pulmonary infection in internal medicine of our hospital from October 2011 to October 2014,got the distribution and drug resistance of pathogenic bacteria with statistical method.Results A total of 582 cases of pathogenic bacteria were isolated.There were 335 cases of gram-negative bacteria (125 cases of Klebsiella pneumonia,83 cases of Escherichia coli),151 cases of gram-positive bacteria (107 cases of staphylococcus aureus),55 cases of fungi (Candida albicans).The sensitivity of Klebsiella pneumoniae to ampicillin was 0％,the sensitivity of Escherichia coli to cefotaxime,ceftazidime were both less than 63％,the sensitivity of pseudomonas aeruginosa and acinetobacter bauman to ampicillin/sulbactam were 0％,61.14％ respectively; the sensitivity of Staphylococcus aureus and coagulase negative staphylococcus to methicillin were 76.29％,57.14％ respectively.Conclusions The distribution of pathogenic bacteria is concentrated in Binhai New Area community diabetes patients with pulmonary infection,with relatively single species and controlled resistance,which may be related to poor facilities for diagnosis and treatment in primary hospital,lack of material specification standardization of nursing staff,physicians' experience medicine.We should perfect the relevant weak link,strengthen the communication between doctors and patients,reasonably use antibacterial drugs with high price performance ratio,reduce economic burden of patients.