2013—2015年某院患者下呼吸道感染病原菌分布及耐药性

Distribution and antimicrobial resistance of pathogens causing lower respiratory tract infection in patients in a hospital, 2013-2015

摘要:

目的探讨下呼吸道感染患者的病原菌分布及耐药性，为临床合理选择抗菌药物提供依据。 方法对某院2013年1月1日—2014年12月31日送检的肺泡灌洗液标本进行培养，采用纸片扩散法对阳性标本菌株进行药敏试验。结果7 702份肺泡灌洗液标本共分离菌株999株，其中细菌、真菌和分枝杆菌分别为398株（5.17%）、326株（4.23%）和275株（3.57%）。细菌主要包括铜绿假单胞菌（97株）、鲍曼不动杆菌（87株）、肺炎克雷伯菌（62株）、金黄色葡萄球菌（44株）、流感嗜血杆菌（28株）；真菌主要包括白假丝酵母菌（161株）、烟曲霉菌（41株）、黄曲霉菌（38株）；分枝杆菌主要包括结核分枝杆菌（271株）。药敏结果显示铜绿假单胞菌对常用抗菌药物（除替卡西林/克拉维酸和左氧氟沙星外）的耐药率均＜30.00%。鲍曼不动杆菌对氨苄西林/舒巴坦、亚胺培南、阿米卡星、庆大霉素和妥布霉素的耐药率均＞80.00%，对其他常用抗菌药物的耐药率介于36.84%~60.53%。62株肺炎克雷伯菌中产超广谱β内酰胺酶（ESBLs）有20株。产ESBLs株的耐药率明显高于非产ESBLs株。44株金黄色葡萄球菌中26株为耐甲氧西林金黄色葡萄球菌（MRSA），金黄色葡萄球菌对青霉素的耐药率为97.73%，对万古霉素、替考拉宁、利奈唑胺的耐药率为0，对其他常用抗菌药物的耐药率介于9.09%~61.36%。结论住院患者下呼吸道感染病原菌以细菌为主，但真菌和分枝杆菌也不容忽视。铜绿假单胞菌对常用抗菌药物的耐药率相对较低，但鲍曼不动杆菌的耐药现象则较严重。

Abstract:

ObjectiveTo explore the distribution and antimicrobial resistance of pathogens causing lower respiratory tract infection in patients, and provide basis for rational choice of antimicrobial agents in clinic. MethodsAll bronchoalveolar lavage fluid specimens in a hospital from January 1, 2013 to December 31, 2014 were performed culture, antimicrobial susceptibility testing of isolated strains was performed with KirbyBauer method. ResultsA total of 999 strains were isolated from 7 702 bronchoalveolar lavage fluid specimens, 398 (5.17%), 326 (4.23%), and 275（3.57%） strains were bacteria, fungus, and Mycobacterium respectively. The main bacteria were Pseudomonas aeruginosa(P. aeruginosa, n=97), Acinetobacter baumannii(A. baumannii, n=87), Klebsiella pneumoniae(K. pneumoniae, n=62), Staphylococcus aureus(S. aureus, n=44), and Haemophilus influenzae (n=28); the main fungi were Candida albicans (n=161), Aspergillus fumigatus (n=41), and Aspergillus flavus(n=38); the main Mycobacterium were Mycobacterium tuberculosis(n=271). Antimicrobial susceptibility testing results showed that resistance rates of P. aeruginosa to the commonly used antimicrobial agents (except ticarcillin/clavulanic acid and levofloxacin) were all<30.00%. Resistance rates of A. baumannii to ampicillin/sulbactam, imipenem, amikacin, gentamicin, and tobramycin were all >80.00%, but to the other commonly used antimicrobial agents were 36.84%-60.53%. Among 62 strains of K. pneumoniae, 20 were extendedspectrum βlactamases(ESBLs)producing strains. Antimicrobial resistance rates of ESBLsproducing strains were obviously higher than nonESBLsproducing strains. Among 44 S. aureus strains, 26 were methicillinresistant S. aureus (MRSA), resistance rate of S. aureus to penicillin was 97.73%, to vancomycin, teicoplanin, and linezolid were all 0, to the other antimicrobial agents were 9.09%-61.36%. ConclusionBacteria is the major pathogen causing lower respiratory tract infection in hospitalized patients, but fungus and Mycobacterium can not be ignored. Resistance rates of P. aeruginosa to commonly used antimicrobial agents is relatively low, but resistance of A. baumannii is more serious.