| 摘要: |
| 目的 了解我院支气管肺泡灌洗液样本中的病原菌分布及其耐药性，为临床合理用药提供参考。方法 收集2016年1月至2019年12月我院送检的615例支气管肺泡灌洗液样本，分离、鉴定病原菌，并进行体外药敏试验。结果 共检出707株非重复病原菌，其中革兰阴性菌593株（83.9%），革兰阳性菌114株（16.1%）；构成比占前3位的病原菌分别为铜绿假单胞菌（171株，24.2%）、肺炎克雷伯菌（147株，20.8%）和鲍曼不动杆菌（97株，13.7%）。革兰阴性菌中，铜绿假单胞菌对碳青霉烯类抗菌药物的耐药率较高，对亚胺培南和美洛培南的耐药率分别为33.3%（57/171）和30.6%（52/170）；肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率较低（<20%），产超广谱β-内酰胺酶菌株的检出率为16.3%（24/147）；鲍曼不动杆菌的耐药率较高，对亚胺培南和美洛培南的耐药率均为85.6%（83/97）。革兰阳性菌中，金黄色葡萄球菌对青霉素耐药率达89.4%（76/85），尚未发现对万古霉素和利奈唑胺耐药的革兰阳性菌，耐甲氧西林金黄色葡萄球菌的检出率为32.9%（28/85）。结论 我院支气管肺泡灌洗液样本中的主要病原菌为革兰阴性菌，主要病原菌的耐药性不容忽视。支气管肺泡灌洗液病原菌检查对于疾病诊断和指导合理使用抗菌药物具有较高的临床价值。 |
| 关键词: 支气管肺泡灌洗液 病原体 革兰阴性菌 革兰阳性菌 耐药性 |
| DOI：10.16781/j.0258-879x.2021.08.0941 |
| 投稿时间：2020-04-20修订日期：2020-09-27 |
| 基金项目:国家自然科学基金青年科学基金（31500721），上海青年临床医技人才（临床检验专业）培养资助计划［沪医卫基（2016）04号］，上海市科学技术委员会项目（17JC1400900）. |
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| Distribution and drug resistance of pathogens in bronchoalveolar lavage fluid |
| LI Ya-zhou,HUANG Xiao-chun,WAN Yu-xiang,LIU Yun* |
(Department of Laboratory Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the distribution and drug resistance of pathogens in bronchoalveolar lavage fluid (BALF) samples in our hospital, so as to provide reference for clinical rational drug use. Methods Pathogens were isolated and identified from 615 BALF samples between Jan. 2016 and Dec. 2019 in our hospital, and drug sensitivity test in vitro was conducted. Results A total of 707 non repetitive pathogens were detected, including 593 (83.9%) Gram-negative bacilli and 114 (16.1%) Gram-positive bacilli. The top 3 pathogens were Pseudomonas aeruginosa (171 strains, 24.2%), Klebsiella pneumoniae (147 strains, 20.8%) and Acinetobacter baumannii (97 strains, 13.7%), respectively. Among the Gram-negative bacilli, Pseudomonas aeruginosa had a higher resistance rate to carbapenems, while the resistance rates to imipenem and meropenem were 33.3% (57/171) and 30.6% (52/170), respectively; Klebsiella pneumoniae had a lower resistance rate to carbapenems (<20%), the extended-spectrum β-lactamase (ESBL) production strains in Klebsiella pneumoniae was 16.3% (24/147); and Acinetobacter baumannii had a higher resistance rate of 85.6% (83/97) to imipenem and meropenem. Among the Gram-positive bacilli, the resistance rate of Staphylococcus aureus to penicillin was 89.4% (76/85). Gram-positive pathogens were not yet resistant to vancomycin and linezolid. The detection rate of methicillin-resistant Staphylococcus aureus was 32.9% (28/85). Conclusion The main pathogens isolated from BALF samples in our hospital are Gram-negative bacilli, and their drug resistance can not be ignored. The detection of pathogens in BALF has high clinical value for disease diagnosis and rational use of antibiotics. |
| Key words: bronchoalveolar lavage fluid pathogens Gram-negative bacteria Gram-positive bacteria drug resistance |
