结构性肺病患者呼吸道病原菌分布及耐药性分析  

Distribution and drug resistance analysis of respiratory pathogens in patients with Structural Pulmonary Disease

作　　者：钱培新[1] 任亚璐[2] 朱琼芳[2] 徐杰[2] Qian Peixin;Ren Yalu;Zhu Qiongfang;Xu Jie(Zhangjiagang First Peoples Hospital,Jiangsu Suzhou 215600,China;Center of Clinical Laboratory,The First Affiliated Hospital of Soochow University,Jiangsu Suzhou,215000,China.)

机构地区：[1]张家港市第一人民医院检验科 [2]苏州大学附属第一医院临床检测中心,江苏苏州215000

出　　处：《实验与检验医学》2022年第6期666-668,682,共4页Experimental and Laboratory Medicine

基　　金：江苏省医学创新团队与领军人才项目,编号CXTDB2017009;江苏省社会发展重点项目临床前沿技术,编号BE2019656。

摘　　要：目的了解结构性肺病患者呼吸道病原菌的分布及其耐药性,为临床合理使用抗菌药物提供参考。方法收集2019年8月至2022年7月我院诊断为结构性肺病患者送检的痰液和肺泡灌洗液样本,分离培养鉴定病原菌,进行体外药敏试验,抗酸染色找结核分枝杆菌。结果419例结构性肺病患者中有250例患者培养为呼吸道正常菌群,检出病原菌169株,其中肠杆菌科36株(8.6%)、非发酵菌59株(14.1%)、金黄色葡萄球菌8株(1.9%)、念珠菌28株(6.7%)、曲霉菌13株(3.1%),找到抗酸杆菌阳性9例(2.1%)。革兰阴性菌中,肺炎克雷伯菌对碳青霉烯类药物的耐药率较高,对亚胺培南和美罗培南的耐药率分别为33.3%(6/18)和55.6%(10/18);铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别达44.0%(11/25);鲍曼不动杆菌对碳青霉烯类、喹诺酮类等泛耐药,耐药率达88.2%(15/17)。金黄色葡萄球菌对苯唑西林的耐药率为87.5%(7/8),尚未发现对万古霉素、替考拉宁、利奈唑胺和替加环素耐药的菌株。结论结构性肺病患者易发生革兰阴性菌、金黄色葡萄球菌、分枝杆菌和曲霉感染,以革兰阴性菌感染为主,主要革兰阴性菌的碳青霉烯类耐药性不容忽视。病原学检查和常见药物敏感性分析有助于结构性肺病患者肺部感染的诊断和抗菌药物的合理使用。Objective To investigate the distribution and drug resistance of respiratory pathogens in patients with structural pulmonary disease,so as to provide reference of clinical rational drug use.Methods Pathogens were isolated and identified from patients with structural pulmonary disease between Aug.2019 and Jul.2022 in our hospital,drug sensitivity test in vitro was conducted and acid fast staining for Mycobacterium tuberculosis.Results 250 normal flora and 169 pathogenic bacteria in 419 patients with structural pulmonary disease were detected,including 36 Enterobacteriaceae(8.6%),59 Non-fermentative bacteria(14.1%),8 Staphylococcus aureus(1.9%),28 Candida(6.7%),13 Aspergillus(3.1%),and 9 acid fast bacteria(2.1%).Among the gram-negative bacilli,Klebsiella pneumoniae had a high resistance rate to carbapenems,while the resistance rates to imipenem and meropenem were 33.3%(6/18)and 55.6%(10/18),respectively;The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 44.0%(11/25);Acinetobacter baumannii was pan-resistant to carbapenems and quinolones,with a resistance rate of 88.2%(15/17).The resistance rate of Staphylococcus aureus to oxacillin was 87.5%(7/8),and Staphylococcus aureus were not yet resistant to vancomycin,teicoplanin,linezolid and tigecycline.Conclusion Patients with structural pulmonary disease are susceptible to infection by Gram-negative bacteria,Staphylococcus aureus,Mycobacterium and Aspergillus.The main pathogens are Gram-negative bacteria,and their carbapenem resistance cannot be ignored.Etiological distribution and drug resistance analysis have high clinical value for the diagnosis of pulmonary infection in patients with structural pulmonary disease and the rational use of antibiotics.

关 键 词：结构性肺病 病原菌 分布 耐药性 

分 类 号：R563[医药卫生—呼吸系统]