2018—2020年多中心下呼吸道标本分离菌分布及耐药性分析

摘要：目的 分析中国11家三级医院2018—2020年下呼吸道标本分离细菌分布及耐药性。方法 采用纸片扩散法、E-test 法、仪器法进行药敏试验，使用WHONET5.6软件，按照CLSI M100-S30标准进行统计分析。结果 2018—2020年11家医院共分 离细菌75553株(剔除同一患者重复株)，其中革兰阳性菌占11.5%，革兰阴性菌占88.5%。前4位细菌依次是肺炎克雷伯菌、鲍曼 不动杆菌、铜绿假单胞菌、金黄色葡萄球菌。下呼吸道标本中MRSA检出率为38.9%，未发现对万古霉素、替考拉宁、利奈唑胺 及替加环素耐药的金黄色葡萄球菌。PRSP、PISP的检出率分别为0.7%和2.9%。肺炎克雷伯菌对碳青霉烯类抗生素的耐药率超 过12%，而大肠埃希菌、阴沟肠杆菌和黏质沙雷菌对碳青霉烯类抗生素的耐药率均低于6%。鲍曼不动杆菌对亚胺培南、美罗培 南的耐药率分别为68.1%和72.3%。铜绿假单胞菌对亚胺培南、美罗培南的耐药率分别为24.1%和20.9%。结论 下呼吸道标本分 离细菌以革兰阴性杆菌为主，各病原菌耐药有其特点，实验室应定期统计分析，为合理使用抗菌药物提供依据。

Distribution and drug resistance analysis of bacteria from lower respiratory tract of multicenters from 2018 to 2020

Abstract Objective To investigate the distribution and antimicrobial resistance of bacteria isolated from lower respiratory tract in 11 hospitals in China from 2018 to 2020. Methods Bacterial susceptibility testing was performed using KB, E-test and MIC. Results were analyzed according to CLSI M100-S30. All data were analyzed using the WHONET5.6 software. Results A total of 75,753 strains of bacteria were isolated from 11 hospitals from2018 to 2020. Gram-negative bacteria accounted for 88.5% and Gram-positive bacteria accounted for 11.5%. The top four bacteria were K. pneumoniae, A. baumannii, P. aeruginosa and S. aureus. The prevalence of MRSA was 38.9%. No S. aureus was resistant to vancomycin, teicoplanin, linezolid and tigecycline. The rates of PRSP and PISP were 0.7% and 2.9% respectively. The resistance rate of K. pneumoniae to carbapenems was more than 12%. The resistance rate of E. coli, E. cloacae and S. marcescens to carbapenems was less than 6%. The resistance rates of E. coli, E. cloacae and S. marcescens to carbapenems were less than 68.1% and 72.3%, respectively. The resistance rates of P. aeruginosa to imipenem and meropenem were 24.1% and 20.9%, respectively. Conclusion Gram negative bacilli are the main bacteria isolated from lower respiratory tract. Each pathogen has its own characteristics of drug resistance, suggesting that the laboratory should make regular statistical analysis to provide basis for rational use of antibiotics.