细菌性肺炎患者病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in patients with bacterial pneumonia

目的探讨细菌性肺炎患者病原菌分布及耐药性。方法选择2018年1月至2020年12月吉林市化工医院收治的1068例细菌性肺炎患者为研究对象。患者入院后,于用药前采集痰标本并分离培养病原菌。采用全自动细菌鉴定/药物敏感分析系统及配套的药敏卡片进行菌株鉴定和药敏试验。结果1068份痰标本中共分离出1097株病原菌,剔除同一患者痰液中相同菌株最终得到1058株病原菌,其中革兰阳性菌105株(9.92%),革兰阴性菌953株(90.08%)。105株革兰阳性菌中,金黄色葡萄球菌95株(90.48%)、肺炎链球菌8株(7.62%)、无乳链球菌2株(1.90%);95株金黄色葡萄球菌中甲氧西林敏感金黄色葡萄球菌(MSSA)45株(47.37%),耐甲氧西林金黄色葡萄球菌(MRSA)50株(52.63%)。953株革兰阴性菌中,构成比最高的5种为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、阴沟肠杆菌,构成比分别为44.28%(422/953)、13.01%(124/953)、8.50%(81/953)、7.87%(75/953)、5.25%(50/953)。肺炎克雷伯菌对阿米卡星、亚胺培南、美罗培南的耐药率(1.0%~1.4%)较低,对头孢唑林的耐药率(33.2%)较高;铜绿假单胞菌对阿米卡星、庆大霉素的耐药率(3.4%~9.5%)较低,对氨曲南的耐药率(37.6%)较高;鲍曼不动杆菌对13种常用抗生素的耐药率(23.8%~45.7%)均较高;大肠埃希菌对阿米卡星、阿莫西林/克拉维酸、亚胺培南、美罗培南、哌拉西拉/他唑巴坦的耐药率(0.0%~8.0%)较低,对其他14种常用抗生素的耐药率(34.7%~93.3%)较高;阴沟肠杆菌对阿莫西林/克拉维酸、氨苄西林、头孢唑啉的耐药率(78.0%~94.0%)较高,对阿米卡星、亚胺培南、美罗培南、哌拉西林/他唑巴坦的耐药率(0.0%~6.0%)较低。MSSA对阿米卡星、阿莫西林/克拉维酸、苯唑西林、利福平、替考拉宁、万古霉素、奎奴普丁/达福普汀、利奈唑胺的耐药率(0.0%~2.1%)较低,MRSA对替考拉宁、万古霉素、奎奴普丁/达福普汀、利奈唑胺的耐药率(0.0%~8.2%)较低。结论细菌性肺炎病原菌以革兰阴性菌为主,临床上应以药敏试验为指导,加强对细菌性肺炎的合理用药,减少病原菌多重耐药菌的产生。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in patients with bacterial pneumonia.Methods A total of 1068 patients with bacterial pneumonia admitted to Jilin City Hospital of Chemical Industry from January 2018 to December 2020 were selected as the research subjects.After the patients admitted to the hospital,sputum samples were collected and the pathogenic bacteria were isolated and cultured before administration.The strain identification and drug susceptibility testing were carried out by the automatic bacterial identification/drug susceptibility analysis system and the supporting drug susceptibility card.Results A total of 1097 strains of pathogenic bacteria were isolated from 1068 sputum specimens,and 1058 strains of pathogenic bacteria were obtained by eliminating the same strains in the sputum of the same patient,including 105 strains(9.92%)of gram-positive bacteria and 953 strains(90.08%)of gram-negative bacteria.Among the 105 strains gram-positive bacteria,95 strains(90.48%)were Staphylococcus aureus,8 strains(7.62%)were Streptococcus pneumoniae,and 2 strains(1.90%)were Streptococcus agalactiae;among the 95 strains of Staphylococcus aureus,45 strains(47.37%)were methicillin-sensitive Staphylococcus aureus(MSSA)and 50 strains(52.63%)were methicillin-resistant Staphylococcus aureus(MRSA).Among the 953 strains of gram-negative bacteria,the five species with the highest constituent ratios were Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae,with a constituent ratio of 44.28%(422/953),13.01%(124/953),8.50%(81/953),7.87%(75/953),5.25%(50/953),respectively.The resistance rate of Klebsiella pneumoniae to amikacin,imipenem and meropenem was lower(1.0%-1.4%),and the resistance rate to cefazolin was higher(33.2%);the resistance rate of Pseudomonas aeruginosa to amikacin and gentamicin was lower(3.4%-9.5%),and the resistance rate to aztreonam was higher(37.6%);the resistance rates of Acinetobacter baumannii to 13 commonly used antibiotics were all higher(23.8%-45.7%);the resistance rates of Escherichia coli to amikacin,amoxicillin/clavulanate,imipenem,meropenem,piperacillar/tazobactam were lower(0.0%-8.0%),and the resistance rates to other 14 commonly used antibiotics were higher(34.7%-93.3%);the resistance rates of Enterobacter cloacae to amoxicillin/clavulanic acid,ampicillin and cefazolin were relatively higher(78.0%-94.0%),and the resistance rates to amikacin,imipenem,meropenem,piperacillin/tazobactam were lower(0.0%-6.0%).The resistance rates of MSSA to amikacin,amoxicillin/clavulanate,oxacillin,rifampicin,teicoplanin,vancomycin,quinupristin/dalfopristin,linezolid were lower(0.0%-2.1%),and the resistance rates of MRSA to teicoplanin,vancomycin,quinupristin/dalfopristin and linezolid were lower(0.0%-8.2%).Conclusion The pathogenic bacteria of bacterial pneumonia are mainly gram-negative bacteria.In clinical practice,the drug sensitivity test can be used as a guide to strengthen the rational drug using for bacterial pneumonia and reduce the generation of multi-drug resistant bacteria.