青海省2015—2020年下呼吸道标本细菌耐药监测分析

目的 了解青海省支气管肺泡灌洗液和合格痰标本来源细菌的耐药性变迁，为青海省下呼吸道病原菌感染抗菌药 物合理应用，以及抗菌药物制定和评价提供数据支持。方法 用WHONET5.6软件分析2015—2020年青海省来自支气管肺泡灌 洗液和合格痰标本分离鉴定的细菌药敏数据，并进行耐药性分析。结果 2015—2020年从支气管肺泡灌洗液和合格痰标本中共 分离出55288株细菌，分离排名前5的细菌分别是肺炎克雷伯菌(22.5%)、鲍曼不动杆菌(10.8%)、大肠埃希菌(9.7%)、金黄色葡萄 球菌(8.7%)和阴沟肠杆菌(7.5%)。药敏数据显示，肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌对大部分监测抗菌药物的敏感性均 有下降趋势，肺炎克雷伯菌相对于大肠埃希菌和阴沟肠杆菌药物敏感性较高，大部分敏感性在90%以上，3种细菌对碳青霉烯 类抗生素的耐药性均略有上升；鲍曼不动杆菌对所有监测抗菌药物的耐药性总体下降，但是耐药率相对较高；铜绿假单胞菌除 对左氧氟沙星的耐药率上升外，对其他抗菌药物的耐药率基本保持不变或下降；6年中MRSA的检出率分别是34.3%、37.0%、 39.0%、36.7%、37.8%和41.4%，未发现对万古霉素、替考拉宁和利奈唑胺耐药的金黄色葡萄球菌。肺炎链球菌对青霉素的敏感 性基本保持在95%左右。结论 青海省2015—2020年支气管肺泡灌洗液和合格痰标本分离的病原菌以革兰阴性菌为主，大部分 抗菌药物耐药率总体呈现下降趋势，碳青霉烯耐药的肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌略有上升，呼吁临床医师送检高 质量的支气管肺泡灌洗液和合格痰标本，并根据细菌药敏结果合理使用抗生素。

Analysis of bacterial resistance surveillance of lower respiratory tract specimens in Qinghai from 2015 to 2020

Abstract Objective To investigate the changes of antimicrobial resistance of bacteria derived from bronchial lavage fluid and qualified sputum, and to provide data support for the rational application of antibacterial drugs for pathogenic infections of lower respiratory tract infections in Qinghai, as well as the formulation and evaluation of antibacterial drugs. Methods WHONET5.6 software was used to analyze the bacterial drug susceptibility data from the isolation and identification of alveolar lavage fluid and sputum specimens in Qinghai from 2015 to 2020, and drug resistance analysis was conducted. Results A total of 55288 strains of bacteria were isolated from bronchial lavage fluid and sputum from 2015 to 2020. The top five bacteria isolated were Klebsiella pneumoniae (22.5%),Acinetobacter baumannii (10.8%), and Escherichia coli (9.7%), Staphylococcus aureus (8.7%), and Enterobacter cloacae (7.5%). Drug susceptibility data showed that Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli had a downward trend in the sensitivity of most monitored antibacterial drugs. Drug resistance of Klebsiella pneumoniae was compared with Escherichia coli and Enterobacter cloacae. The drug sensitivity was high, most of which were above 90%. The resistance of the three bacteria to carbapenem antibiotics increased slightly; the resistance of Acinetobacter baumannii to all monitored antimicrobial drugs decreased overall, but the drug resistance rate was relatively high; the resistance rate of Pseudomonas aeruginosa to levofloxacin increased, while the resistance rate to other antibacterial drugs basically remained unchanged or decreased; the detection rates of MRSA in 6 years were 34.3%, 37.0%, 39.0%, 36.7%, 37.8%, and 41.4%. Vancomycin, teicoplanin and linezolid-resistant Staphylococcus aureus were not found. The sensitivity of Streptococcus pneumoniae to penicillin was basically maintained at about 95%. Conclusion Gram-negative bacteria were mainly pathogenic and isolated from bronchial lavage fluid qualified sputum in Qinghai, 2015-2020. The resistance rates to most antimicrobial drugs generally decreased. Carbapenemresistant Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli increased slightly. Clinicians are called on to send high-quality bronchial lavage fluid and sputum specimens, and use antibiotics based on the results of bacterial susceptibility.