2019—2023年四川地区支气管肺泡灌洗液分离细菌分布及耐药性分析  

Distribution and antimicrobial resistance profiles of bacteria isolated from bronchoalveolar lavage fluid in Sichuan region from 2019 to 2023

作　　者：宋克强 喻华[2] 黄湘宁[2] SONG Keqiang;YU Hua;HUANG Xiangning(Department of Laboratory Medicine,Emeishan People’s Hospital,Emeishan Sichuan 614200,China)

机构地区：[1]峨眉山市人民医院检验科,四川峨眉山614200 [2]四川省医学科学院•四川省人民医院(电子科技大学附属医院)临床医学检验中心

出　　处：《中国感染与化疗杂志》2024年第6期708-715,共8页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解四川地区2019—2023年支气管肺泡灌洗液(BALF)分离细菌的分布和耐药情况,为临床抗菌药物选择提供参考。方法按照全国细菌耐药监测网(CARSS)技术方案对细菌进行鉴定和药敏试验(包括纸片扩散法及自动化仪器法),按CLSI M1002022年版标准判读结果。结果共收集26575株细菌,其中革兰阴性菌83.2%,革兰阳性菌16.8%。主要细菌依次为肺炎克雷伯菌(19.8%)、铜绿假单胞菌(18.5%)、鲍曼不动杆菌(12.3%)、金黄色葡萄球菌(7.7%)、嗜麦芽窄食单胞菌(6.7%)。药敏结果显示,金黄色葡萄球菌中未检出万古霉素、替考拉宁、利奈唑胺耐药株,甲氧西林耐药金黄色葡萄球菌(MRSA)检出率为32.5%。肺炎链球菌对青霉素的耐药率为1.5%,对红霉素和克林霉素耐药率>90%。流感嗜血杆菌β内酰胺酶检出率为63.3%,对左氧氟沙星敏感率>90%。大肠埃希菌对碳青霉烯类耐药率低于5%,对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦均<15%。肺炎克雷伯菌对碳青霉烯类耐药率逐年升高,从2019年的11.1%上升至2023年的19.1%。鲍曼不动杆菌对大部分抗菌药物的耐药率>50%。铜绿假单胞菌对碳青霉烯类药物耐药率约15%。结论四川地区BALF标本分离菌以革兰阴性菌为主,耐药率呈上升趋势。针对下呼吸道感染病例,临床应当提高高质量BALF标本的送检率,并且重视病原菌的监测,及时了解呼吸道感染部位病原菌分布及对抗菌药物耐药性,为临床科学的经验性治疗提供依据。Objective To understand the distribution and antimicrobial resistance of bacteria isolated from bronchoalveolar lavage fluid(BALF)in Sichuan Province over a five-year period,and provide a reference for antimicrobial therapy.Methods Bacteria were identified and subjected to antimicrobial susceptibility testing(including disk diffusion and automated systems)according to the protocol of the China Antimicrobial Resistance Surveillance System(CARSS).The results were interpreted according to the breakpoints recommended in CLSI M100(2022 Edition).Results A total of 26575 strains of bacteria were included in this study,of which 83.2%were Gram-negative bacteria and 16.8%were Gram-positive bacteria.The top bacteria species were Klebsiella pneumoniae(19.8%),Pseudomonas aeruginosa(18.5%),Acinetobacter baumannii(12.3%),Staphylococcus aureus(7.7%),and Stenotrophomonas maltophilia(6.7%).None of S.aureus strains were resistant to vancomycin,teicoplanin,or linezolid.The prevalence of methicillin-resistant S.aureus(MRSA)was 32.5%.The resistance rate of Streptococcus pneumoniae to penicillin was 1.5%,and the resistance rate to erythromycin and clindamycin was>90%.The prevalence ofβ-lactamase-producing strains was 63.3%in Haemophilus influenzae,while>90%of H.influenzae strains were susceptible to levofloxacin.Less than 5%of E.coli strains were resistant to carbapenems,and less than 15%of the strains were resistant to cefoperazone-sulbactam and piperacillin-tazobactam.The resistance rate of K.pneumoniae to carbapenems increased year by year,from 11.1%in 2019 to 19.1%in 2023.The resistance rate of A.baumannii to most antimicrobial agents was>50%.The resistance rate of P.aeruginosa to carbapenems was about 15%.Conclusions The main bacteria isolated from BALF specimens in Sichuan Province are Gramnegative bacteria.The antimicrobial resistance of the bacterial isolates is on the rise.For the patients suspected of lower respiratory tract infection,clinical practitioners should collect more high-quality BALF specimens for microbiology tes

关 键 词：支气管肺泡灌洗液 下呼吸道感染 药物敏感性试验 耐药变迁 

分 类 号：R378[医药卫生—病原生物学]