下呼吸道肺泡灌洗液病原菌分布及耐药性分析

An Analysis of Pathogen Distribution and Drug Resistance in AlveolarLavage Fluid of Lower Respiratory Tract

目的探讨呼吸系统疾病患者支气管肺泡灌洗液培养的病原菌分布及耐药情况。方法回顾性分析2018年10月至2023年3月首都医科大学附属北京中医医院呼吸系统疾病住院患者的肺泡灌洗液(BALF)标本培养及药敏结果。结果收集我院呼吸科住院患者符合入组标准的BALF标本共547例,培养出病原菌株共117株,总阳性率为21.39%,其中革兰阴性菌属92株(78.63%)、革兰阳性菌属10株(8.55%)、真菌15株(12.82%)。主要致病菌为革兰阴性菌属,检出的前四位分别为铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌和肺炎克雷伯菌。药敏显示铜绿假单胞菌对于阿米卡星敏感率最高,鲍曼不动杆菌对阿米卡星、头孢他啶、环丙沙星、头孢吡肟、美洛培南、哌拉西林、妥布霉素、哌拉西林/他唑巴坦、亚胺培南的耐药率均高于83%,大肠埃希菌对哌拉西林、氨苄西林/舒巴坦的耐药率高达91.67%,肺炎克雷伯菌对头孢呋辛钠、头孢呋辛酯、哌拉西林及氨苄西林/舒巴坦的耐药率偏高,达到55.56%;革兰阳性菌检出率最高的为金黄色葡萄球菌,其对青霉素的耐药率最高,达到85.71%;真菌感染以白假丝酵母菌为主,对两性霉素、5’氟胞嘧啶、常见康唑类药物均敏感。结论我院呼吸道疾病患者肺泡灌洗液培养的病原菌以铜绿假单胞菌和鲍曼不动杆菌等非发酵菌为主,其中鲍曼不动杆菌的耐药率最高,提倡临床应根据相应药敏试验结果合理使用抗生素。

Objective To investigate the distribution of pathogenic bacteria and drug resistance in bronchoalveolar lavage fluid cultures of patients with respiratory diseases.Methods A retrospective analysis was conducted for culture and drug sensitivity results of alveolar lavage fluid(BALF)specimens from inpatients with respiratory diseases in Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,from October,2018 to March,2023.Results A total of 547 BALF specimens were collected from inpatients of our Respiratory Department who met the enrollment criteria,and a total of 117 pathogenic strains were cultured,with an overall positive rate of 21.39%,including 92 strains of Gram-negative genera(78.63%),10 strains of Gram-positive genera(8.55%),and 15 strains of fungi(12.82%).The main pathogenic bacteria were Gram-negative genera,and the top four detected were Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Klebsiella pneumoniae.The drug sensitivity showed that Pseudomonas aeruginosa had the highest sensitivity rate to amikacin,while the resistance rates of Acinetobacter baumannii to amikacin,ceftazidime,ciprofloxacin,cefepime,meropenem,piperacillin,tobramycin,piperacillin/tazobactam and imipenem were higher than 83%,and the resistance rates of Escherichia coli to piperacillin and ampicillin/sulbactam were as high as 91.67%,and Klebsiella pneumoniae to cef The resistance rate of Klebsiella pneumoniae to cefuroxime sodium,cefuroxime ester,piperacillin and ampicillin/sulbactam was high,reaching 55.56%;The highest rate of Gram-positive bacteria detected was Staphylococcus aureus,which had the highest resistance rate to penicillin,reaching 85.71%;Fungal infections were dominated by Pseudomonas albicans,which were sensitive to amphotericin,5’flucytosine and common conazole drugs.Conclusion The pathogenic bacteria cultured in alveolar lavage fluid of patients with respiratory diseases in our hospital are mainly non-fermentative bacteria,such as Pseudomonas aeruginosa and Acinetobacter baumannii,among which the resistance rate of Acinetobacter baumannii is the highest.It is advocated that clinical antibiotics should be used reasonably according to the results of corresponding drug sensitivity tests.