难治性下呼吸道感染患者BALF病原菌分布及药敏分析

目的：探讨新疆自治区人民医院难治性下呼吸道感染患者支气管镜肺泡灌洗液( BALF)病原菌分布及其药敏状况，为临床合理用药提供依据。方法收集2013年6月到2015年5月难治性下呼吸道感染中BALF标本，对分离培养结果及药敏实验结果进行回顾性分析；结果难治性下呼吸道感染肺泡灌洗阳性患者255例，共培养出287株病原菌，革兰阳性菌占26．5%，革兰阴性菌占70．7%，真菌占2．8%，革兰阴性菌中排列于前4位的主要菌种依次是肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌，其中鲍曼不动杆菌普遍耐药程度最高，对亚胺培南和美罗培南耐药率较高，分别为68%、64%，对米诺环素及阿米卡星最为敏感；革兰阳性菌主要为金黄色葡萄球菌41株。未见万古霉素耐药菌株。结论难治性下呼吸道感染患者肺泡灌洗液主要以革兰阴性杆菌为主，各种病原菌对抗菌药物的敏感度各不相同，差异较大，加强病原菌耐药性检测有助于治疗方案的制定或调整，及早控制感染。

Distribution and antimicrobial resistance of bacterial isolates from bronchoalveolar lavage fluid of refractory broncho-pulmonary infection

Objective To analyze the distribution and antimicrobial resistance pattern of pathogenic bacteria isolates from bronchoalveolar lavage fluid ( BALF) of refractory broncho-pulmonary infections patients, in order to guide the rational use in clinical settings. Methods The clinical bacteria isolates of bronchoalveolar lavage fluid samples were collected from refractory broncho-pulmonary infection patients from June 2013 to July 2015. The distri-bution of bacteria and antimicrobial susceptibility test of pathogen were retrospectively analyzed. Results 287 posi-tive pathogenic strains were separated from 255 persistent broncho-pulmonary infections patients. Gram-negative bacteira took up for 70. 7%, gram-positive bacteria for 26. 5% and fungi for 2. 8%. Gram-negative bacteira mainly included Klebsiella pneumoniae, Pseudomonas aeruginosa, E. coli and acinetobacter baumannii. Acinetobacter bau-mannii showed the highest resistance to common drugs, especially for imipenem and meropenem (68%, 64%), and high sensitivity to minocycline and amikacin. Gram-positive bacteria mainly included staphylococcus aureus ( 41 strains). Conclusion The gram-negative bacteria infection accounts for the majority isolates from BALF of persistent broncho-pulmonary infection. The situation of antibiotic resistance is rigorous. According to the antibiotic resistance spectrum of bacteria, we can select antibiotic reasonably to control infections at early stage.