呼吸与危重症医学科感染性肺炎患者痰培养结果病原学分布及耐药分析

Etiological Distribution and Drug Resistance Analysis of Sputum Culture Results of Patients with Infectious Pneumonia in Department of Respiratory and Critical Care Medicine

摘要: 目的：分析呼吸与危重症医学科普通病房与重症监护病房感染性肺炎患者痰培养阳性结果病原菌的分布特点及其耐药情况，为患者抗感染治疗提供合理用药依据。方法：采用BDPhoenix100全自动微生物分析仪和琼脂稀释法进行细菌鉴定和药物敏感测试。药敏结果根据美国临床实验室标准化协会(CLSI) 2021年版标准进行判读。对感染性肺炎患者痰标本进行病原菌的分离鉴定和药敏试验，利用WHONET5.6软件进一步分析病原菌的分布特点及其耐药情况。结果：2021年9月至2022年9月青岛市中心医院呼吸与危重症医学科送检痰标本共分离出298株非重复菌株，其中革兰阳性菌25株(8.39%)，分别是金黄色葡萄球菌18株(6.04%)、肺炎链球菌6株(2.01%)，停乳链球菌1株(0.34%)；革兰阴性菌273株(91.61%)，占比前5位分别是肺炎克雷伯菌77株(25.84%)、铜绿假单胞菌63株(21.14%)、鲍曼不动杆菌42株(14.09%)、大肠埃希菌25株(8.39%)和嗜麦芽寡养食单胞菌21株(7.05%)。金黄色葡萄球菌均对奎奴普丁/达福普汀、万古霉素、利福平、莫匹罗星、利奈唑胺、替考拉宁敏感。肺炎克雷伯菌对常见抗菌药物均存在不同程度耐药，对碳青霉烯类药物、阿米卡星、多粘菌素最为敏感，耐药率较高的分别是氯霉素、环丙沙星、头孢噻肟、氨苄西林/舒巴坦。铜绿假单胞菌对喹诺酮药物的耐药率较高，左氧氟沙星、环丙沙星的耐药率分别为28.57%、22.22%，对氨曲南的耐药率也较高，为26.98%。鲍曼不动杆菌耐药现象尤为严重，对各类常用抗生素耐药率均达40.00%以上。大肠埃希菌对喹诺酮类、头孢类抗生素耐药明显。嗜麦芽寡养食单胞菌对大多数常见抗菌药天然耐药药敏结果显示对复方新诺明耐药率最低，为14.29%，对左氧氟沙星、氯霉素、头孢他啶的耐药率分别为19.05%、28.57%、57.14%。结论：呼吸与危重症医学科痰标本分离菌对常见抗菌药物存在不同程度耐药，细菌耐药率仍在逐年上升，形势严峻，作为全球公共卫生问题应高度重视。依据药敏结果结合患者病情合理制定治疗方案、加强地方细菌耐药监控及医务人员院感意识尤为重要。

Abstract: Objective: To analyze the distribution characteristics and drug resistance of pathogenic bacteria from sputum culture positive patients with infectious pneumonia in general wards and intensive care units of respiratory and critical care medicine departments, so as to provide rational drug use basis for anti infection treatment of patients. Methods: BDPhoenix100 automatic microbiological analyzer and agar dilution method were used for bacterial identification and drug sensitivity test. The drug sensitivity results were interpreted according to the 2021 edition of the American Associ-ation for Clinical Laboratory Standardization (CLSI). The sputum samples of patients with infectious pneumonia were isolated, identified and tested for drug sensitivity. The distribution characteristics and drug resistance of pathogens were further analyzed by WHONET5.6 software. Results: From September 2021 to September 2022, a total of 298 non repetitive strains were isolated from spu-tum samples submitted by the Department of Respiratory and Critical Care Medicine of Qingdao Central Hospital, including 25 strains of Gram-positive bacteria (8.39%), 18 strains of Staphylococ-cus aureus (6.04%), 6 strains of Streptococcus pneumoniae (2.01%), and 1 strain of Streptococcus lactis (0.34%); 273 strains of Gram-negative bacteria (91.61%), the top 5 were Klebsiella pneu-moniae 77 strains (25.84%), Pseudomonas aeruginosa 63 strains (21.14%), Acinetobacter bau-mannii 42 strains (14.09%), Escherichia coli 25 strains (8.39%) and Maltrophomonas maltophilia 21 strains (7.05%). Staphylococcus aureus were sensitive to quinuputin/dafopratin, vancomycin, ri-fampicin, mupirocin, linezolid and teicoplanin. Klebsiella pneumoniae has different degrees of re-sistance to common antibacterial drugs, and is most sensitive to carbapenems, amikacin, and poly-myxin. The high resistance rates are chloramphenicol, ciprofloxacin, cefotaxime, ampicil-lin/sulbactam, respectively. The resistance rate of Pseudomonas aeruginosa to quinolones was high, the resistance rates of levofloxacin and ciprofloxacin were 28.57% and 22.22% respectively, and the resistance rate to aztreonam was also high, 26.98%. The drug resistance of Acinetobacter bau-mannii is particularly serious, and the drug resistance rate to various commonly used antibiotics is more than 40.00%. Escherichia coli was resistant to quinolones and cephalosporins. The results of natural drug resistance of Stenotrophomonas maltophilia to most common antibiotics showed that the drug resistance rate to compound sulfamethoxazole was the lowest, 14.29%, and the drug re-sistance rates to levofloxacin, chloramphenicol, and ceftazidime were 19.05%, 28.57%, and 57.14%, respectively. Conclusion: The bacteria isolated from sputum samples of the respiratory and critical care medical department are resistant to common antibiotics to varying degrees, and the rate of bacterial resistance is still rising year by year. The situation is serious, and as a global public health problem, great attention should be paid to it. It is particularly important to formulate treatment plans based on drug sensitivity results and patients’ conditions, strengthen local bacterial re-sistance monitoring and hospital sense awareness of medical staff.