117例肺泡灌洗液阳性老年下呼吸道感染患者病原菌分布及耐药性分析  

Distribution of pathogenic bacteria and drug resistance analysis in 117 elderly patients with alveolar lavage fluid positive and lower respiratory tract infections

作　　者：夏珺 李泉 张吉 曾建涛 吴永琴 刘钉宾 XIA Jun;LI Quan;ZHANG Ji;ZENG Jiantao;WU Yongqin;LIU Dingbin(Department of Clinical Laboratory,Changshou District People′s Hospital,Chongqing 401220,China)

机构地区：[1]重庆市长寿区人民医院检验科,重庆401220

出　　处：《检验医学与临床》2024年第12期1806-1810,共5页Laboratory Medicine and Clinic

基　　金：重庆市长寿区科技计划项目(CSKJ2023-042)。

摘　　要：目的分析肺泡灌洗液(BALF)阳性的老年下呼吸道感染患者相关病原菌的分布和耐药性,为老年下呼吸道感染的预防及合理用药提供依据。方法对该院2020年1月1日至2023年6月30日送检的高度怀疑下呼吸道感染的664例住院老年患者BALF标本进行培养,采用微量肉汤稀释法进行药敏试验。结果BALF标本中分离出病原菌147株,BALF标本阳性率为22.1%(147/664)。排除来自同一患者的重复分离菌株后,分离的病原菌为117株。117株病原菌中革兰阳性菌占7.7%,革兰阴性菌占72.6%,真菌占19.7%。其中革兰阴性菌以鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为主;革兰阳性菌以肺炎链球菌、金黄色葡萄球菌为主;真菌以白色假丝酵母菌为主。分离出117株病原菌的下呼吸道感染患者中,医院获得性肺炎46例(39.3%),社区获得性肺炎71例(60.7%)。药敏试验结果显示:鲍曼不动杆菌对呋喃妥因和头孢唑啉耐药率最高,为100.0%,对亚胺培南、美罗培南耐药率均为84.0%,对多黏菌素B、米诺环素、头孢噻肟耐药率均为0.0%;铜绿假单胞菌对氨苄西林/舒巴坦耐药率最高,为85.7%,对复方磺胺甲噁唑、氯霉素、米诺环素耐药率分别为64.3%、78.6%、45.5%;肺炎克雷伯菌除对氨苄西林天然耐药外,对其他测试药物的耐药率在0.0%~35.3%;白色假丝酵母菌对伏立康唑、两性霉素B均敏感。结论老年下呼吸道感染患者BALF标本检出病原菌以革兰阴性菌为主,其中鲍曼不动杆菌的耐药情况较严重,真菌感染也应该引起重视。Objective To analyze the distribution and drug resistance of related pathogenic bacteria in the elderly patients with bronchoalveolar lavage fluid(BALF)positive lower respiratory tract infection so as to provide a basis for the prevention and rational drug use for elderly lower respiratory tract infection.Methods The submitted BALF specimens from 664 elderly in patients with highly suspected of lower respiratory tract infection in this hospital from January 1,2020 to June 30,2023 conducted the culture.The drug susceptibility test was performed by the broth microdilution method.Results A total of 147 strains of pathogenic bacteria were isolated from BALF specimens,with a positive rate of 22.1%(147/664).After excluding duplicate strains from the same patient,there were 117 strains of isolated pathogenic bacteria.Among 117 pathogenic bacteria,Gram positive bacteria accounted for 7.7%,Gram negative bacteria accounted for 72.6%,and fungi accounted for 19.7%.Among them,Gram negative bacteria were mainly Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumoniae;Gram positive bacteria were mainly Streptococcus pneumoniae and Staphylococcus aureus;The fungi are mainly Candida albicans.Among the 117 strains of pathogenic bacteria isolated from patients with lower respiratory tract infections,46 cases(39.3%)were hospital acquired pneumonia and 71 cases(60.7%)were community acquired pneumonia.The results of the drug susceptibility test showed that Acinetobacter baumannii had the highest resistance rate to furantoin and ceftriaxone,which was 100.0%.The resistance rates to imipenem and meropenem all were 84.0%,and the resistance rates to polymyxin B,minocycline and cefotaxime all were 0.0%;Pseudomonas aeruginosa had the highest resistance rate to ampicillin/sulbactam,which was 85.7%,and resistance rates to compound sulfamethoxazole,chloramphenicol and minocycline were 64.3%,78.6%,and 45.5%,respectively;Klebsiella pneumoniae had the natural resistance to ampicillin,in addition its resistance rates to commonly use

关 键 词：下呼吸道感染 肺泡灌洗液 病原菌 耐药性 老年患者 

分 类 号：R446.5[医药卫生—诊断学] R56[医药卫生—临床医学]