下呼吸道感染患者支气管肺泡灌洗液病原菌分布及耐药性分析

Distribution and drug resistance analysis of pathogenic bacteria in bronchoalveolar lavage fluid of patients with lower respiratory tract infection

目的探讨下呼吸道感染患者支气管肺泡灌洗液病原菌分布及对常用抗菌药物药敏结果,为临床合理用药提供依据。方法回顾性分析焦作市人民医院2019年1月—2020年12月下呼吸道感染患者支气管肺泡灌洗液定量分离培养结果。结果365例患者主要来源于呼吸与危重症医学科269例,占73.7%;血液病科26例,占7.1%;重症监护病房20例,占5.5%;风湿免疫科13例,占3.6%。病原菌以革兰阴性杆菌为主,116例,占82.3%,排在前3位的是肺炎克雷伯氏菌(39株,27.7%)、鲍曼不动杆菌(35株,24.8%)和铜绿假单胞菌(25株,17.7%);真菌19株,占13.5%,其中念珠菌属13株,曲霉菌属5株,青霉菌属1株;革兰阳性球菌6株,占4.3%,主要为肺炎链球菌(3株,2.1%);肺炎克雷伯氏菌对亚胺培南、美罗培南耐药率分别为36.1%、35.6%;鲍曼不动杆菌对亚胺培南、美罗培南耐药率均为94.2%、94.2%;铜绿假单胞菌对亚胺培南、美罗培南耐药率分别为34.0%、22.0%。结论支气管肺泡灌洗液主要病原菌为革兰阴性杆菌,以肺炎克雷伯氏菌、鲍曼不动杆菌和铜绿假单胞菌为主,各病原菌耐药情况严重。医生应结合临床资料,综合判读细菌培养结果,参照药敏结果合理用药,加强多重耐药菌监测,降低多重耐药菌肺部感染的发生率。

Objective To investigate the distribution of pathogenic bacteria in bronchoalveolar lavage fluid of patients with lower respiratory tract infection and the results of susceptibility to commonly used antibacterial drugs,so as to provide a basis for clinical rational use of drugs.Methods The results of quantitative separation and culture of bronchoalveolar lavage fluid from patients with lower respiratory tract infection from January 2019 to December 2020 in Jiaozuo City People’s Hospital were retrospectively analyzed.Results The 365 patients were mainly from the Department of Respiratory and Critical Care Medicine,269 cases,accounting for 73.7%,the Department of Hematology,26 cases,accounting for 7.1%,the intensive care unit,20 cases,accounting for 5.5%,and the Department of Rheumatology and Immunology,13 cases,accounting for 3.6%.The main pathogens are Gram-negative bacilli,accounting for 82.3%.The top 3 are Klebsiella pneumoniae(39 strains,27.7%),Acinetobacter baumannii(35 strains,24.8%)and Pseudomonas aeruginosa(25 strains,17.7%);19 strains of fungi,accounting for 13.5%,of which 13 strains of Candida,5 strains of Aspergillus,1 strain of Penicillium;6 strains of Gram-positive cocci,accounting for 4.3%,mainly Streptococcus pneumoniae(4 strains,2.1%);the resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 36.1%and 35.6%,respectively;Acinetobacter baumannii was resistant to imipenem and meropenem The drug rates were both 94.2%and 94.2%;the drug resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 34.0%and 22.0%,respectively.Conclusion The main pathogenic bacteria in bronchoalveolar lavage fluid were Gram-negative bacilli,mainly Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa,and the resistance of each pathogen was serious.Doctors should combine clinical data,comprehensively interpret bacterial culture results,use drug susceptibility results rationally,strengthen monitoring of multidrug-resistant bacteria,and reduce the incidence of multidrug-resistant bacteria pulmonary infection.