呼吸病区患者支气管肺泡灌洗液中病原菌分布及耐药性分析

摘要

Objective To investigate the distribution and drug resistance of pathogens in bronchoalveolar lavage flu-id in patients from respiratory ward,and to provide evidence for clinical treatment and infection control.Methods The distribution and drug sensitivity results of bronchoalveolar lavage fluid in patients from respiratory ward from January 2013 to December 2015 were retrospectively analyzed,WHONET 5.6 was used for the statistics of drug resistance.Re-sults 588 strains were isolated from 2356 bronchoalveolar lavage fluid cultures.Gram negative bacilli were 415 strains (70.6%),gram-positive cocci were 86 strains (14.6%),fungi were 87 strains (14.8%).The resistance rate of ceftazi-dime,piperacillin/tazobactam,cefoperazone/sulbactam,imipenem and cefepime to Pseudomonas aeruginosa was below 10%;The resistance rate of ampicillin/sulbactam,gentamicin and amikacin to Acinetobacter baumanii were 66.3%, 72.4% and 75.5% respectively,the rate of other antibiotics was below 30%;The resistance rate of imipenem and mer-openem to Klebsiella pneumoniae were all 2.8%,the rate of ESBLs was 31.9%;The incidence ofβ-lactamases of Hae-mophilus influenzae was 33.3%;The rates of MRSA was 38.9%.The rates of PISP and PSSP were 3.3%and 96.7%respectively.Conclusions In our hospital,the main pathogens in bronchoalveolar lavage fluid in patients from respirato-ry ward were Pseudomonas aeruginosa and Acinetobacter baumanii,and the resistance rate of Acinetobacter baumanii is higher.It is need to rational?use drug according to corresponding pathogenic detection results and drug resistance mo-nitoring data.%目的：探讨呼吸病区患者支气管肺泡灌洗液中病原菌的分布及耐药性，为临床治疗和感染防控提供依据。方法回顾分析2013年1月至2015年12月呼吸病区患者支气管肺泡灌洗液病原菌的分布及药敏结果，采用 whonet 5.6进行耐药性统计。结果2356名患者支气管肺泡灌洗液标本共分离出588株病原菌。其中革兰阴性菌415株（70.6％），革兰阳性菌86株（14.6％），真菌87株（14.8％）。铜绿假单胞菌对头孢他啶、哌拉西林他唑巴坦、头孢哌酮舒巴坦、亚胺培南和头孢吡肟的耐药率均低于10％。鲍曼不动杆菌对氨苄西林舒巴坦、阿米卡星和庆大霉素的耐药率较高，分别为66.3％、72.4％和75.5％，对其他抗菌药物的耐药率在30％以下。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率均为2.8％，ESBLs 的发生率为31.9％。流感嗜血杆菌β-内酰胺酶的发生率为33.3％。甲氧西林耐药的金黄色葡萄球菌（MRSA）发生率为38.9％；青霉素中介的肺炎链球菌（PISP）和青霉素敏感的肺炎链球菌（PSSP）比例分别为3.3％和96.7％。结论我院呼吸病区患者支气管肺泡灌洗液中病原菌以铜绿假单胞菌和鲍曼不动杆菌等非发酵菌为主，且鲍曼不动杆菌的耐药率较高，临床需依据相应病原学检测结果及耐药监测资料合理用药。