中国西部地区2016-2017年下呼吸道标本分离细菌的分布及耐药性

目的 分析2016—2017年西部地区下呼吸道感染患者的分离菌的分布及耐药性。方法 采用自动化仪器MIC法、 纸片扩散法(KB法)和E-Test法结合对临床分离株进行药敏试验，并按2017年CLSI标准判断药敏试验结果，采用WHONET 5.6 软 件，对我国西部10家医院(贵州、新疆、四川、宁夏、内蒙古、陕西、云南、青海、重庆 、甘肃)呼吸道标本分离菌作回顾性 统计分析。结果 2016—2017年西部十家医院呼吸道标本共分离49643株细菌，革兰阴性菌占81.9%，革兰阳性菌为18.1%。 常见细菌依次为肺炎克雷伯菌(18.7%)、鲍曼不动杆菌(14.6%)、铜绿假单胞菌(12.2%)、金黄色葡萄球菌(11.3%)、肺炎链球菌 (6.8%)、流感嗜血菌(6.7%)、大肠埃希菌(6.5%)、嗜麦芽寡养单胞菌(4.8%)、阴沟肠杆菌(4.3%)等。药敏结果显示对于肺炎链球 菌儿童分离株中第三代头孢菌素耐药率(头孢曲松7.8%、头孢噻肟7.1%)高于成人分离株(头孢曲松7.3%、头孢噻肟6.2%)，但对 左氧氟沙星的耐药株较成人组少(儿童1%、成人2.8%)。两年MRSA检出率分别为39.5%和37.2%。未发现万古霉素、利奈唑胺和 替考拉宁耐药株。流感嗜血菌对氨苄西林的耐药率均在45.5%左右。肺炎克雷伯菌、大肠埃希菌对第三代头孢菌素耐药率分别 为31%和65%。对3种碳氢酶烯类药物的耐药率肺炎克雷伯菌在8%左右。铜绿假胞菌对抗菌药物的耐药率较低，低于<30%，对 碳氢酶烯类药物耐药率在23%左右。鲍曼不动杆菌除了米诺环素其余抗菌药物耐药率>50%，对碳青霉烯类药物耐药率在70%左 右。结论 呼吸道分离菌以阴性杆菌为主，且耐药率呈增长趋势，临床应重视耐药监测结果，合理使用抗菌药物。

Pathogenic characteristics and drug resistance of lower respiratory tract infection in Western China from 2016 to 2017

Objective To investigate the distribution and drug resistance of bacteria isolated from patients with lower respiratory tract infection in Western China from 2016 to 2017. Methods Bacterial susceptibility testing was performed using the MIC, KB or E-Test method. Results were analyzed according to CLSI 2017. All data were analyzed using the WHONET5.6 software. Results A total of 49643 strains of bacteria were isolated from respiratory secretion of ten hospitals in Western China from 2016—2017. Gram-negative bacteria accounted for 81.9% and Grampositive bacteria accounted for 18.1%. The common bacteria were K. pneumoniae(18.7%), A. baumannii (14.6%), P. aeruginosa (12.2%), S. aureus (11.3%), S. pneumoniae (6.8%), H. influenzae (6.7%), E. coli (6.5%), S. maltophilia (4.8%), and E. cloacae (4.3%). Results of antimicrobial susceptibility showed that the third generation cephalosporium were isolated from Streptococcus pneumoniae strains in children. The rate of resistance to levofloxacin was higher than that of adult isolates The constitutional ratios of methicillin-resistant Staphylococcus aureus were 39.5% and 37.2%. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. There were 45.5% of H. influenzae resistant to ampicillin. There were 31% and 65% of E.coli and K. pneumoniae resistant to third generation cephalosporium,and 8% to hydrocarbon enzymes. Lower than 30% of P. aeruginosa strains were resistant to most antibacterials. Morer than 50% of A. baumannii strains were resistant to most antibacterials except minocycline. Conclusion Gram-negative bacilli were still the most common pathogens in respiratory tract infections associated with serious antibiotic resistance. Bacterial resistance to commonly used antibiotics was still on the rise. Therefore, we should pay attention to the results of drug resistance monitoring and use antibiotics