呼吸科支气管肺泡灌洗液革兰阴性杆菌耐药性分析

Analysis of drug resistance of negative Gram bacilli in BALF

目的了解医院呼吸科肺部感染患者支气管肺泡灌洗液(BALF)革兰阴性杆菌的构成及耐药情况,为合理使用抗菌药物和医院感染控制提供参考。方法对医院2012年-2014年呼吸科肺部感染患者BALF分离的革兰阴性杆菌进行回顾性分析。结果 582例患者BALF标本共分离728株革兰阴性杆菌,主要为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌,分别占32.7%、18.8%、12.6%和10.2%。药敏结果显示:大肠埃希菌和肺炎克雷伯菌的ESBLs检出率为74.3%和36.5%;对亚胺培南耐药率分别为2.7%和29.9%。铜绿假单胞菌对大部分抗菌药物的敏感性较好,对大部分抗菌药物的耐药率<26%;对亚胺培南的耐药率为28.2%。鲍曼不动杆菌多重耐药性严重,对亚胺培南耐药率为63.0%。结论呼吸科肺部感染患者BALF中常见革兰阴性杆菌多为条件致病菌,其耐药情况较为严重,应加强细菌耐药监测,以指导合理用药和医院感染控制。

Objective To investigate th distribution and resistance characteristic of negative Gram bacilli in bronchoalveolar lav- age fluid（BALF） samples from patients with pulmonary infection in respiratory medicine of our hospital, so as to provide basis for the reasonable use of antibiotics and hospital infection control. Methods Negative Gram bacilli, isolated from BALF sam- ples of patients with pulmonary infection in respiratory medicine of our hospital from 2012 to 2014, were analyzed retrospective-＂ ly. Results A total of 728 strains of negative Gram bacilli were isolated from 582 BALF samples, which were mainly Pseudo- monas aeruginosa, Klebsiella pneumoniae, Acinetobater baumannii, Escherichia coli, accounting for 32.7%, 18.8%, 12.6% and 10.2%, respectively. The drug sensitivity test showed that the extended spectrum 13 -lactamase（ESBLs） positive rates of Escherichia coli and Klebsiella pneumoniae were 74.3% and 36.5% , respectively, and the drug resistance rates of them to imi- penem were 2.7% and 29.9%, respectively. Pseudomonas aeruginosa showed high sensitivity to the majority of common anti- biobics with the drug resistance rate less than 26%, while its resistance to imipenem was 28.2%. Acinetobater baumannii showed multiple drug resistance to many common antibiotics. The drug resistance rate of Acinetobater baumannii to imipenem was 63.0%. Conclusion The negative Gram bacilli from BALF samples in patients with pulmonary infection in respiratory medicine were mostly opportunistic pathogens with a severer drug resistance problem. Antibiotic resistance surveillance should be strengthened to guide rational antibiotic administration and hospital infection control.