2014-2018年支气管镜肺泡灌洗液主要病原菌及其耐药性分析

目的探讨2014—2018年支气管镜肺泡灌洗液主要病原菌及其耐药性。方法选取2014—2018年在东南大学附属南京市胸科医院住院的感染患者690例,均采用支气管镜检查,并对肺泡灌洗液进行细菌培养及药敏试验进行分析。结果2014—2018年支气管镜肺泡灌洗液检出主要病原菌690株,包括革兰阴性菌393株(56.96%),革兰阳性菌86株(12.46%),真菌211株(30.58%)。2014—2018年主要革兰阴性菌中肺炎克雷伯菌对哌拉西林耐药率较高,为37.06%;铜绿假单胞菌对常见抗生素敏感,耐药率均低于30.00%;大肠埃希菌对头包他啶、环丙沙星、哌拉西林、左氧氟沙星耐药率较高,均超过30.00%。2014—2018年表皮葡萄球菌、溶血葡萄球菌及耐甲氧西林金黄色葡萄球菌(MRSA)均未见对莫西沙星、达托霉素、万古霉素、利奈唑胺耐药,其中表皮葡萄球菌对头孢曲松、复方新诺明、利福平、红霉素、环丙沙星耐药率均超过75.00%,溶血葡萄球菌对头孢曲松、复方新诺明、利福平、红霉素、环丙沙星耐药率均超过50.00%,MRSA对头孢曲松、复方新诺明、利福平、红霉素、四环素、环丙沙星耐药率均超过40.00%。2014—2018年革兰阳性菌多重耐药率逐年降低,革兰阴性菌多重耐药率逐年升高(P<0.01)。结论2014—2018年革兰阴性菌包括肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌是下呼吸道疾病感染主要病原菌,且其耐药性逐年升高,故临床应根据药敏试验合理用药以降低耐药性。

Main Pathogenic Bacteria of Bronchoscopy Alveolar Lavage Fluid and the Drug Resistance Analysis from 2014 to 2018

Objective To discuss main pathogenic bacteria of bronchoscopy alveolar lavage fluid and the drug resistance analysis from 2014 to 2018.Methods 690 infected patients were selected for bronchoscopy in Nanjing Chest Hospital Affiliated to Southeast University from 2014 to 2018,and they were tested with bronchoscopy,and the bacterial culture and drug susceptibility test of alveolar lavage fluid were analyzed.Results From 2014 to 2018,690 main pathogenic bacteria were detected from bronchoscopy alveolar lavage fluid,including 393 Gram-negative bacteria(56.96%),86 Gram-positive bacteria(12.46%)and 211 fungi(30.58%).From 2014 to 2018,in Gram-negative bacteria,klebsiella pneumoniae had high resistance to piperacillin,resistance rate was 37.06%;the sensitive and resistance rate of pseudomonas aeruginosa to common antibiotics were all lower than 30.00%;escherichia coli had high resistance to fortum,ciprofloxacin,piperacillin and levofloxacin,resistance rate were all more than 30.00%.Staphylococcus epidermidis,staphylococcus haemolyticus and MRSA were not resistant to moxifloxacin,daptomycin,vancomycin,linezolid,resistance rate of staphylococcus epidermidis to ceftriaxone,selectrin,rifampicin,erythromycin,ciprofloxacin were more than 75.00%,resistance rate of staphylococcus haemolyticus to ceftriaxone,selectrin,rifampicin,erythromycin,ciprofloxacin were more than 50.0%,and resistance rate of MRSA to ceftriaxone,selectrin,rifampicin,erythromycin,tetracycline,ciprofloxacin were more than 40.0%.The multi-drug resistance rate of Gram-positive bacteria decreased year by year from 2014 to 2018,and the multi-drug resistance rate of Gram-negative bacteria increased year by year(P<0.01).Conclusion Gram-negative bacteria including klebsiella pneumoniae,pseudomonas aeruginosa and escherichia coli are the main pathogens of lower respiratory tract disease infection from 2014 to 2018,and with high drug resistance,so clinical drug use should be reasonable according to drug sensitivity test to reduce drug resistance.