大理地区支气管肺泡灌洗液标本病原菌分布及细菌耐药性监测  

Distribution and Drug Resistance Monitoring of Pathogenic Bacteria in Bronchoalveolar Lavage Fluid Samples in Dali

作　　者：杜娟 李薇 杨红樱 桑卫洪 马万红 杨维 张雁玲 杨庆和 Du Juan;Li Wei;Yang Hong-ying;Sang Wei-hong;Ma Wan-hong;Yang Wei;Zhang Yan-ling;Yang Qing-he(Dali Bai Autonomous Prefecture People's Hospital,Dali,Yunnan 671000)

机构地区：[1]大理州人民医院,云南大理671000

出　　处：《国外医药（抗生素分册）》2022年第2期115-119,共5页World Notes on Antibiotics

摘　　要：目的 了解下呼吸道感染的病原菌分布特征及耐药现状,为临床诊治下呼吸道感染提供依据。方法 收集4881例支气管肺泡灌洗液(Bronchoalveolar lavage fluid,BALF)标本微生物培养结果,回顾性分析分离菌种的构成及分离率较高菌种的耐药性。结果 共分离菌株568株,培养阳性率11.6%,去除同一患者在一次住院期间重复分离的菌株后,共收集菌株472株,包括革兰阴性菌236株(50.0%),革兰阳性菌116株(24.6%),真菌120株(25.4%)。分离率排在前6位的菌种是铜绿假单胞菌(19.5%)、肺炎链球菌(14.0%)、白色假丝酵母菌(11.7%)、烟曲霉菌(6.6%)、肺炎克雷伯菌肺炎亚种(5.9%)及金黄色葡萄球菌(5.5%)。铜绿假单胞菌对亚胺培南、美罗培南的耐药率为16.7%、15.5%,对头孢他啶、哌拉西林/他唑巴坦及庆大霉素等常用抗菌药物的耐药率都在20%以下;肺炎克雷伯菌肺炎亚种超广谱β-内酰胺酶(ESBLs)阳性率34.8%,对亚胺培南、美罗培南及厄他培南的耐药率均为3.8%。肺炎链球菌对青霉素G的耐药率3.6%,对红霉素、克林霉素及四环素高度耐药。耐甲氧西林金黄色葡萄球菌(MRSA)检出率36.4%,未检出对万古霉素及利奈唑胺耐药的金黄色葡萄球菌。结论 下呼吸道感染的病原菌菌种呈多样性,以革兰阴性菌占主要地位,铜绿假单胞菌及肺炎链球菌是引起下呼吸道感染的主要病原菌,真菌中检出率较高的是白色念珠菌及烟曲霉菌。已有碳青霉烯类耐药的铜绿假单胞菌及肺炎克雷伯菌肺炎亚种出现,ESBL阳性及MRSA等多重耐药菌株的检出率也不低。临床应重视BLAF标本的病原学监测,关注下呼吸道感染的病原菌构成及细菌耐药性变化,防止多重耐药菌株的传播,规范化诊治下呼吸道感染。Objective To understand the distribution characteristics and drug resistance of pathogenic bacteria in lower respiratory tract infection,so as to provide the basis for clinical diagnosis and treatment of lower respiratory tract infection.Method The microbial culture results of 4881 samples of bronchoalveolar lavage fluid were collected,and the composition of isolated strains and drug resistance of strains with higher isolation rate were analyzed retrospectively.Results A total of 568 strains were isolated and the positive rate of culture was 11.6%.After removing the strains repeatedly isolated from the same patient during one hospitalization,a total of 472 strains were collected,including 236 gram-negative strains (50.0%),116 gram-positive strains (24.6%) and 120 fungi (25.4%).The top 6 isolates were Pseudomonas aeruginosa (19.5%),Streptococcus pneumoniae (14.0%),Candida albicans (11.7%),Aspergillus fumigatus (6.6%),Klebsiella pneumoniae subspecies pneumoniae (5.9%) and Staphylococcus aureus (5.5%).The drug resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 16.7% and 15.5%,and the drug resistance rates to ceftazidime,piperacillin/tazobactam and gentamicin were all below 20%.The positive rate of ultra-broad spectrum β-lactamase (ESBLs) of Klebsiella pneumoniae subspecies was 34.8%,and the resistance rates of imipenem,meropenem and ertabenem were 3.8%.The resistance rate of Streptococcus pneumoniae to penicillin G was 3.6%,and it was highly resistant to erythromycin,clindamycin and tetracycline.The detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 36.4%,and no Staphylococcus aureus resistant to vancomycin and linezolid was detected.Conclusion The pathogenic bacteria species of lower respiratory tract infection are diverse,and gram-negative bacteria are the main pathogenic bacteria,among which Pseudomonas aeruginosa and Streptococcus pneumoniae are the main pathogenic bacteria causing lower respiratory tract infection,and Candida albicans and Aspergillus fumigatus have

关 键 词：支气管肺泡灌洗液 下呼吸道感染 病原菌 耐药性 

分 类 号：R978.1[医药卫生—药品]