慢性阻塞性肺疾病急性加重期患者下呼吸道多重耐药菌感染的分布及耐药性分析

Distribution and drug resistance analysis of multidrug-resistant organism causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者下呼吸道多重耐药菌感染的病原菌分布及其对常用抗菌药物的耐药性。方法收集浙江省台州医院2015年6月至2017年5月收治的1 213例AECOPD合并下呼吸道感染患者合格的痰液样本,用Vitek2 Compact系统联合K-B纸片扩散法对菌株进行鉴定和药敏试验。结果共分离出多重耐药菌366株,其中非发酵菌185株(50.55%),肠杆菌科细菌84株(22.95%),多重耐药革兰阳性球菌97株(26.50%)。耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌分别检出83株和14株,对大部分常用抗菌药物均高度耐药;耐碳青霉烯类肠杆菌科细菌检出18株,对β-内酰胺类、氟喹诺酮类、氨基糖苷类(阿米卡星除外)和米诺环素耐药率均≥70%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别检出45株和52株,对青霉素类、氟喹诺酮类、红霉素、四环素、克林霉素、庆大霉素均高度耐药,对万古霉素、替考拉宁和利奈唑胺均无耐药。结论 AECOPD下呼吸道多重耐药菌感染以非发酵菌、肠杆菌科细菌和耐甲氧西林葡萄球菌为主,其中耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌、耐碳青霉烯类肠杆菌科细菌感染多重耐药现象尤为严重;未发现对万古霉素、替考拉宁和利奈唑胺耐药的MRSA和MRCNS。

Objective To investigate the pathogen distribution and drug resistance of multidrug-resistant organism causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods The qualified sputum samples from 1213 patients with AECOPD complicated with lower respiratory tract infections were collected in Taizhou hospital of Zhejiang province from June 2015 to May 2017. Vitek 2 Compact system combined with Kirby-Bauer（K-B）disk diffusion method were used for strain identification and drug susceptibility test. Results A total of 366 strains of multiresistance were isolated,in which 185 strains were nonfermentative bacteria （50.55%）,84 strains were enterobacteriaceae（22.95%）,and 97 strains were multiresistant gram positive coccus（26.50%）.There were 83 strains of carbapenem-resistant acinetobacter baumannii and 14 strains of pseudomonas aeruginosa,which were highly resistant to most commonly used antibiotics. 18 strains of carbapenem-resistant enterobacteriaceae were detected,and their resistant rates to β-lactams,fluoroquinolones,aminoglycosides（except amikacin）and minocycline were all higher than 70%. Among methicillin-resistant staphylococcus aureus,45 strains were methicillin-resistant staphylococcus aureus（MRSA）and 52 strains were methicillin-resistant coagulase negative staphylococcus（MRCNS）.MRSA and MRCNS were highly resistant to penicillins,fluoroquinolones,erythromycin,tetracycline,clindamycin and gentamycin,and no strains were found resistant to vancomycin, teicoplanin and linezolid.Conclusion Nonfermentative bacteria,enterobacteriaceae and methicillin-resistant staphylococcus were the most prevalent multiresistant bacterial pathogens in lower respiratory tract infections in patients with AECOPD. The multi-drug resistance of carbapenem-resistant acinetobacter baumannii,carbapenem-resistant pseudomonas aeruginosa and carbapenemresistant enterobacteriaceae were especially serious. No strains of MRSA and MRCNS resistant to vancomycin,teicoplanin and linezolid.