2017—2022年山东地区肺泡灌洗液分离菌的构成及药物敏感性分析  

Bronchoalveolar lavage fluid pathogenic bacteria composition and antibiotic susceptibility analysis in Shandong Province from 2017 to 2022

作　　者：李政[1,2] 于文文 张春艳 纪冰[3] 满思金 伊茂礼[5] 李仁哲[6] 王世富[1,2,7] 王梦园[1,2] Li Zheng;Yu Wenwen;Zhang Chunyan;Ji Bing;Man Sijin;Yi Maoli;Li Renzhe;Wang Shifu;and Wang Mengyuan(Clinical Microbiology Department,Children's Affiliated Hospital to Shandong University,Ji'nan 250022;Shandong Province Pediatric Antimicrobial Resistance Surveillance System,Shandong Province Children's Microbiomics Research Center,Ji'nan 250022;Department of Laboratory Medicine,Affiliated Hospital of Binzhou Medical College,Binzhou 256603;Department of Laboratory Medicine,Tengzhou Central People's Hospital,Tengzhou 277500;Department of Laboratory Medicine,Yantai Yuhuangding Hospital,Yantai 264000;Department of Laboratory Medicine,First People's Hospital of Jining,Jining 272111;Shandong Provincial Clinical Research Center for Children's Health and Disease,Ji'nan 250022)

机构地区：[1]山东大学附属儿童医院临床微生物科,济南250022 [2]山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网,济南250022 [3]滨州医学院附属医院检验科,滨州256603 [4]滕州市中心人民医院检验科,滕州277500 [5]烟台毓璜顶医院检科,烟台264000 [6]济宁市第一人民医院检验科,济宁272111 [7]山东省儿童健康与疾病临床医学研究中心,济南250022

出　　处：《中国抗生素杂志》2024年第8期944-953,共10页Chinese Journal of Antibiotics

基　　金：国家科技重大专项(No.2017ZX10103004-007);山东省儿童健康与疾病临床医学研究中心项目(No.RC006);济南卫健委科技计划(No.2022-1-45)。

摘　　要：目的了解山东地区成人和儿童肺泡灌洗液的分离菌株的构成及耐药性。方法回顾分析2017年1月—2022年12月山东省儿童细菌耐药监测研究协作网(SPARSS)59家网点单位支气管肺泡灌洗液(BALF)中分离菌株的分布及药物敏感性。结果共收集BALF中分离菌12992株,前五位细菌分别为铜绿假单胞菌(16.51%)、肺炎克雷伯菌(14.66%)、鲍曼不动杆菌(13.97%)、金黄色葡萄球菌(9.21%)、嗜麦芽窄食单胞菌(6.27%);儿童分离菌占21.44%,主要为金黄色葡萄球菌(19.74%)、肺炎链球菌(17.73%)和流感嗜血杆菌(13.60%);成人分离菌占78.56%,主要为铜绿假单胞菌(19.01%)、肺炎克雷伯菌(16.59%)和鲍曼不动杆菌(16.35%)。BALF分离革兰阴性菌占75.0%,成人分离的肺炎克雷伯菌、大肠埃希菌对头孢曲松/头孢噻肟的耐药率分别为36.6%/31.0%和67.1%/61.0%,儿童株为57.5%/62.1%和71.1%/68.1%。成人分离肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌对碳青霉烯类药物的耐药率分别为7.7%~8.3%、2.4%~3.3%、16.5%~19.2%和85.2%~85.3%,儿童分离株为15.4%~16.2%、3.2%~4.9%、11.9%~13.8%和34.7%~45.0%,成人CRKP和CRBA的检出率自2017年的1.2%和70.6%升至2022年的12.5%和84.4%。儿童和成人分离的流感嗜血杆菌对氨苄西林的耐药率分别为83.3%和78.7%,BLNAR株的检出率分别为9.3%和12.0%。革兰阳性菌占17.7%,以金黄色葡萄球菌和肺炎链球菌为主,成人与儿童的耐甲氧西林金黄色葡萄球菌检出率分别为22.58%和29.73%,分别从2017年的42.3%和36.8%降至2022年的19.6%和26.6%,成人与儿童青霉素敏感的肺炎链球菌检出率分别为97.4%和94.6%,未发现对万古霉素或利奈唑胺耐药的金黄色葡萄球菌和肺炎链球菌。结论2017—2022年山东地区成人与儿童BALF分离菌株的构成和药物敏感性存在较大差异,应加强当地流行病学及耐药性的监测,把握不同人群病原谱和耐药性的特点及变化趋势,以便合理经�Objective To understand the isolated bacteria composition and antibiotic susceptibility of bronchoalveolar lavage fluid(BALF)in adults and children from Shandong.Methods The distribution and antibiotic susceptibility of BALF pathogens isolated from 59 units of Shandong Province Pediatric Antimicrobial Resistance Surveillance System(SPARSS)from January 2017 to December 2022 were retrospectively analyzed.Results A total of 12,992 strains of isolates and fungi recovered from BALF were collected,and the top five species were Pseudomonas aeruginosa(16.51%),Klebsiella pneumoniae(14.66%),Acinetobacter baumannii(13.97%),Staphylococcus aureus(9.21%),and Stenotrophomonas maltophilia(6.27%).Children isolates accounted for 21.44%,mainly S.aureus(19.74%),Streptococcus pneumoniae(17.73%)and Haemophilus influenzae(13.60%).Adult isolates accounted for 78.56%,mainly P.aeruginosa(19.01%),K.pneumoniae(16.59%)and A.baumannii(16.35%).The Gram-negative bacteria isolated from BALF accounted for 17.6%.The resistance rates of K.pneumoniae and Escherichia coli isolated from adults to ceftriaxone/cefotaxime were 36.6%/31.0%and 67.1%/61.0%,respectively,and those of children were 57.5%/62.1%and 71.1%/68.1%.The resistance rates of K.pneumoniae,E.coli,P.aeruginosa and A.baumannii to carbapenems in adults were 7.7%~8.3%,2.4%~3.3%,16.5%~19.2%and 85.2%~85.3%,respectively,while those in children were 15.4%~16.2%,3.2%~4.9%,11.9%~13.8%,and 34.7%~45.0%.The detection rates of CRKP and CRBA in adults increased from 1.2%and 70.6%in 2017 to 12.5%and 84.4%in 2022.The resistance rates of H.influenzae in children and adults to ampicillin were 83.3%and 78.7%,respectively,and the detection rates of BLNAR strain were 9.3%and 12.0%,respectively.Gram-positive bacteria accounted for 38.56%,mainly S.aureus and S.pneumoniae.The detection rates of methicillin-resistant S.aureus in adults and children were 22.58%and 29.73%,which decreased from 42.3%and 36.8%in 2017 to 19.6%and 26.6%in 2022,respectively.The detection rates of penicillin-sensitive S.pneumoniae in adult

关 键 词：肺泡灌洗液 成人 儿童 病原谱 药物敏感性监测 

分 类 号：R978[医药卫生—药品]