The Bacteria Of Drug Resistant And Analysis Of Drug Resistance In Hospital Acquired Pneumonia

Objetives: through the experiments on hospital acquired pneumonia in patients with lower respiratory tract secretions(including sputum,bronchial secretions,bronchoalveolar lavage fluid)for culture and drug susceptibility test in vitro in 2009 and 2014 in our hospital,and comparing the results,we can understand the multiple drug-resistant bacteria detection rate and drug resistance characteristics of change of hospital acquired pneumonia in patients,which provides basis for understanding the change of drug-resistant bacteria and clinical rational use of antibiotics.Methods: according to diagnostic and treatment guidelines of the hospital-acquired pneumonia in 2012,HAP patients who conform to the diagnosis were collected from January to December in 2009 and in 2014 in our hospital(rui kang affiliated hospital of guangxi medical university).By investigating the clinical data of patients,including gender,age,previous medical history,check-in desk,and the use of antimicrobial agents,we analyse the bacteria type of lower respiratory tract and drug susceptibility in vitro experiment according to the laboratory results,and have a systematic analysis on the data obtained,then select one of the most common kinds of drug-resistant bacteria.Then by having an unified comparison and analysis,we can get to understand the distribution and change of drug-resistant bacteria of hospital-acquired pneumonia.Results: There were 323 HAP patients in total selected in 2009 and2014 in our hospital.There were 96 male cases and 46 female cases in 2009 and 124 male cases and 58 female cases in 2014.The patients aged above 65 in these two groups accounted for 71.13% and 79.46% respectively.The course is longer,usually more than 30 days.In 2009,patients with HAP were common in neurology,neurosurgery,geriatrics,heart medicine,and renal medicine.While patients with HAP were common in geriatrics department of neurosurgery,neurology,cardiology,ICU in 2014.The rate of espiratory secretions in 2009 was 83.10% and the rate of germiculture positive was 84.75%;The rate of espiratory secretions in 2014 was 81.77%,and the rate of germiculture positive was 87.16%,which were mainly gram-negative bacteria.In 2009,the top five Gram-negative bacteria mainly included acinetobacter(17.48),pneumoniae(13.60%),Pseudomonas aeruginosa(10.68%),escherichia coli(6.80%),stenotrophomonas maltophilia(5.83%).The other staphylococcus aureus accounted for 7.77%.Fungi,10.68% is given priority to with white candida.The top five Gram-negative bacteria in2014 mainly included klebsiella pneumoniae(16.54%),acinetobacter(15.79%),escherichia coli(15.04%),Pseudomonas aeruginosa(7.52%),and stenotrophomonas maltophilia(7.52%).The other staphylococcus aureus accounted for 8.27%,and the fungi was 11.28%.Before the patients were infected with HAP,there were 83 people had broad-spectrum antimicrobial treatment in 2009 and cultivated 37 bead multi-resistant bacteria;In 2014,there were 114 people had broad-spectrum antimicrobial treatment and cultivated 52 bead multi-resistant bacteria.The results of drug sensitive in vitro suggest: The pathogenic bacterium of HAP patients for most commonly used antimicrobial drug resistancewere higher,including acinetobacter had a high drug resistance rate in cephalosporins and penicillin both in the two groups,and the drug resistance rate of Penicillium carbon alkene antimicrobial agents was obviously higher in the year 2014 than in 2009;Pseudomonas aeruginosa had a higher drug resistance rate to gentamicin,and had a lower drug resistance rate to carbapenems and quinolones;Klebsiella pneumoniae had a higher drug resistance rate to the first and second cephalosporin antibiotics and gentamicin both in the two groups,and had a lower drug resistance rate to the third cephalosporin antibiotics and quinolone antibacterial agents,and found no resistance in Cefperazone-Sulbactam;Escherichia coli had a high Resistance to most antimicrobial agents in the two years,but it had a antibiotic sensitive rate to Penicillium carbon alkene antimicrobial agents;Stenotrophomonas maltophilia had a antibiotic sensitive rate to ciprofloxacin,Cefperazone-Sulbactam and Ampicillin/sulbactam in both two groups,but had a higher drug resistance rate to cephalosporins,amikacin and gentamicin,and it were completely resistance to carbapenems including meropenem and imipenem;In the two groups,staphylococcus aureus had a higher sensitive to vancomycin,linezolid,teicoplanin and Cefperazone-Sulbactam,but had a higher drug resistance rate to Penicillin G,,their stead ning,cefoperazone/shu,high sensitivity,to penicillin G,ampicillin and erythromycin;Enterococcus,in the two groups vancomycin had a higher sensitive to enterococcus faecium and enterococcus faecalis;clindamycin,tetracycline and compound sulfamethoxazole had a higher drug resistance to the two kinds of enterococcus;The main infection of fungal is candida albicans,and it had a higher sensitive to Ketoconazole,miconazole,amphotericin B,itraconazole,fluconazole and 5-fluorine cytosine,and the difference in two years is very small.Conclusions: HAP patients selected in our hospital in 2009 and 2014 were mainly elderly men,who usually had long course of disease and most had used antibacterial drugs before.HAP patients are usually common in ICU,neurology,neurosurgery,geriatrics,heart medicine,renal medicine.Inspection rate of lower respiratory tract secretion had decresed slightly in2014 and germiculture positive rate increased compared with it in 2009.The pathogenic bacteria that were detected mainly were gram-negative bacteria.compared with 2009 in 2014 with klebsiella pneumoniae significantly increased and acinetobacter reduced significantly.The vitro susceptibility test results suggest little difference between two groups of HAP pathogenic bacteria drug resistance phenomenon.Both of them are very serious and have different degrees of drug resistance towards a variety of common antimicrobial agents.