基于MALDI-TOF MS检测肺泡灌洗液病原菌分布和耐药性分析

目的 了解呼吸危重症医学科和重症监护病房(Intensive care unit,ICU)肺部疾病患者支气管肺泡灌洗液(Bronchoalveolar lavage fluid,BALF)病原菌种类及其耐药性。方法 回顾性分析2017年1月～2018年12月我院呼吸危重症医学科和ICU肺部疾病患者BALF分离的病原菌种类及耐药性情况。采用基质辅助激光解吸电离飞行时间质谱(Matrix-assisted laser desorption/ionization time of flight mass spectrometry,MALDI-TOF MS)对病原菌进行鉴定。结果 BALF阳性检出率为17.80%(162/910),共分离培养出病原菌191株,其中真菌98株(51.31%),以念珠菌、曲霉菌和新生隐球菌为主;革兰阴性杆菌共90株(47.12%),以鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为主,多药耐药鲍曼不动杆菌对亚胺培南和美罗培南的耐药率均为58.33%,对头孢哌酮/舒巴坦和替加环素的耐药率分别为45.83%、16.67%,对哌拉西林/他唑巴坦及头孢类药物的耐药率均大于54.0%。其他革兰阴性杆菌对常用抗菌药物的耐药率不高。结论 基于MALDI-TOF MS鉴定的BALF病原菌种类多样,以真菌和革兰阴性杆菌为主,其中鲍曼不动杆菌多药耐药现象严重。病原菌的准确鉴定和敏感药物使用为临床提供治疗依据。

Analysis of distribution and drug resistance of pathogenic bacteria in alveolar lavage fluid based on MALDI-TOF MS

Objective To understand the pathogens and drug resistance of Bronchoalveolar lavage fluid(BALF)in patients with respiratory diseases and intensive care unit(ICU).Methods The pathogens and drug resistance of BALF isolated from patients with respiratory critical medical disease and ICU lung disease in our hospital from January 2017 to December 2018 were retrospectively analyzed.Pathogenic bacteria were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF MS).Results The positive detection rate of BALF was 17.80%(162/910).A total of 191 pathogens were isolated and cultured,among which 98 strains(51.31%)were fungi,mainly Candida,Aspergillus and Cryptococcus neoformans.Gram-negative bacilli 90 strains(47.12%)were isolated and cultured,mainly Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae.The resistance rates of multidrug-resistant Acinetobacter baumannii to imipenem and meropenem were all 58.33%.The resistance rates to cefoperazone/sulbactam and tigecycline were 45.83% and 16.67%,respectively,and the resistance rates to piperacillin/tazobactam and cephalosporins were more than 54.0%.The resistance rate of other Gram-negative bacilli to commonly used antibiotics was not high.Conclusion The pathogens of BALF identified by MALDI-TOF MS are diverse,mainly including fungi and Gram-negative bacilli.The multidrug resistance of Acinetobacter baumannii is serious.The accurate identification of pathogenic bacteria and the use of sensitive drugs provide clinical treatment basis.