肺移植受者主要革兰阴性菌分布与耐药性分析

目的 探讨肺移植受者主要革兰阴性菌的分布及耐药性特点,为临床经验性抗感染治疗提供用药参考。方法 对2010年1月-2014年12月肺移植受者送检的标本,采用法国生物梅里埃公司VITEK-2全自动细菌鉴定及药敏分析仪进行细菌鉴定及药敏分析,使用WHONET 5.4进行统计分析。结果 1 412份标本中共分离出病原菌636株,检出率为45.04％;其中革兰阴性菌525株,排名前4位病原菌依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌,分别占38.10％,17.33%,16.76%和8.57%。标本主要来源为痰液（73.27%）和支气管灌洗液（22.33%）。鲍曼不动杆菌仅对头孢哌酮/舒巴坦耐药率 <60.00%。铜绿假单胞菌对阿米卡星、庆大霉素、头孢哌酮/舒巴坦、头孢吡肟、头孢他啶、亚胺培南、美罗培南、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星、妥布霉素耐药性<30.00％。肺炎克雷伯菌对亚胺培南、美罗培南敏感性高,耐药率分别为7.69%和0.00%;对阿米卡星、头孢他啶、哌拉西林/他唑巴坦也较敏感,耐药率为23.08% ～27.47%。大肠埃希菌对头孢唑啉、头孢呋辛耐药率为100.00%,耐药率<30.00％的有头孢哌酮/舒巴坦、头孢西丁、哌拉西林/他唑巴坦、呋喃妥因和妥布霉素,未发现耐亚胺培南和美罗培南菌株。结论 肺移植受者分离的的革兰阴性菌以鲍曼不动杆菌和肺炎克雷伯杆菌等为主,不同种类菌株药敏结果差异较大,需继续加强细菌耐药性监测和预警工作。

Distribution and drug resistance of main gram-negative pathogens in lung transplantation patients

Objective To explore the distribution and drug resistance of the main gram-negative bacteria derived from lung transplantation patients in our hospital,and to provide guidance for empiric antimicrobial therapy. Methods Clinical specimens from Jan. 2010 to Dec. 2014 were collected from lung transplantation patients. The bacterial identification was carried out by using VITEK-2 automatic bacterial identification system of BioMerieux,France,and the drug susceptibility testing was performed with the use of drug susceptibility analyzer. Statistical analysis was performed with WHONET 5.4.Results A total of 636 strains of pathogens were isolated from 1412 specimens and the detection rate was 45.04％. Among them 525 strains were gram-negative bacteria,the acinetobacter baumannii,klebsiella pneumoniae,pseudomonas aeruginosa and escherichia coli ranked the top four species,accounting for 38.10%,17.33%,16.76% and 8.57% respectively. The main source of the specimen was sputum(73.27%)and bronchoalveolar lavage(22.33%).The resistance rate of acinetobacter baumannii to all of the antimicrobial agents was more than 60.00% except cefperazone-sulbactam. The resistant rate of pseudomonas aeruginosa to amikacin,gentamicin,cefoperazone－sulbactam,cefepime,ceftazidime,imipenem,meropenem,piperacillin-tazobactam,ciprofloxacin,levofloxacin and tobramycin was less than 30.00% respectively. The resistant rate of klebsiella pneumoniae to imipenem and meropenem was 7.69% and 0.00% respectively. They were also sensitive to amikacin,ceftazidime and piperacillin-tazobactam with the resistance rate of 23.08% ～27.47%. The resistance rate of escherichia coli to cefazolin,cefuroxime,ampicillin was 100.00%;The resistance rate of escherichia coli to cefoperazone-sulbactam,cefoxitin,piperacillin-tazobactam,nitrofurantoin,and tobramycin were less than 30.00%. No strain of escherichia coli was found to be resistant to imipenem and meropenem. Conclusion The acinetobacter baumannii and klebsiella pneumoniae are the main gram-negative bacteria isolated from lung transplantation patients,which vary significantly in the drug susceptibility. Monitoring and early warning of bacterial resistance should be strengthened.