摘要
目的分析呼吸科患者下呼吸道感染病原谱以及病原菌对常用抗生素的耐药性,从而为呼吸科患者下呼吸道感染精准治疗提供参考依据。方法收集2018-2020年自福建医科大学附属三明第一医院呼吸内科接受诊治的患者痰液、支气管肺泡灌洗液、胸水、支气管冲洗液、气管吸出物样本中分离的1002株下呼吸道病原菌进行菌种鉴定,并测定这些病原菌对哌拉西林、头孢吡肟、头孢他啶、美罗培南、亚胺培南、环丙沙星、左旋氧氟沙星、阿米卡星、庆大霉素、妥布霉素、奈替米星、复方新诺明、粘菌素、替加环素等常用抗生素的耐药性。结果自患者下呼吸道分离的1002株病原菌中,85.13%为革兰阴性菌、14.87%为革兰阳性菌(χ^(2)=467.21,P<0.001),鲍曼不动杆菌(25.05%)、铜绿假单胞菌(21.86%)和肺炎克雷伯菌(17.07%)占分离菌株的前三位。鲍曼不动杆菌对粘菌素敏感性最高(86.86%),对哌拉西林耐药性最高(96.41%);铜绿假单胞菌对粘菌素敏感性最高(92.27%),对替加环素耐药性最高(85.73%)。肠杆菌中,大肠埃希菌对粘菌素敏感性最高(98.09%),对头孢呋辛耐药性最高(66.70%);肺炎克雷伯菌对粘菌素敏感性最高(81.17%),对头孢噻肟耐药性最高(80.64%);沙雷菌对阿米卡星敏感性最高(97.07%),对头孢噻肟耐药性最高(52.33%);变形杆菌对美罗培南敏感性最高(94.93%),对复方新诺明耐药性最高(70.28%);柠檬酸杆菌对阿米卡星敏感性最高(100.00%),对头孢噻肟耐药性最高(49.81%)。革兰阳性菌中,金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素100.00%敏感、粪肠球菌对利奈唑烷100.00%敏感,屎肠球菌对左旋氧氟沙星100.00%耐药。流感嗜血杆菌对氯霉素敏感性最高(96.87%),对青霉素耐药性最高(52.94%);卡他莫拉菌对左氧氟沙星敏感性最高(98.33%),对阿米卡星耐药性最高(70.90%)。结论革兰阴性菌是引发呼吸内科患者下呼吸道感染的主要病原菌,其中以鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为主。鲍曼不动杆菌对常见抗生素的耐药性普遍较高,肺炎链球菌对常见抗生素的耐药率均不超过50.00%。
Objective To investigate the distribution of pathogenic bacterial isolates for lower respiratory tract infections among patients admitted to department of respiratory medicine and to test their susceptibility to common antibiotics,so as to provide insights into precision treatment of lower respiratory tract infections among patients admitted to department of respiratory medicine.Methods A total of 1002 pathogenic bacterial isolates from sputum,bronchoalveolar lavage,pleural fluid,bronchial washing and tracheal aspirate samples were collected from patients with lower respiratory tract infections admitted to Department of Respiratory Medicine,Sanming First Hospital,The Affiliated Hospital of Fujian Medical University during the period from 2018 to 2020.The bacterial isolates were subjected to species characterization,and their susceptibility to piperacillin,cefepime,ceftazidime,meropenem,imipenem,ciprofloxacin,levofloxacin,amikacin,gentamicin,tobramycin,netilmicin,trimethoprim/sulfamethoxazole,colistin and tigecycline was tested.Results Among the 1002 pathogenic isolates,85.13%were Gram-negative and 14.87%were Gram-positive(χ^(2)=467.21,P<0.001),and Acinetobacter baumannii(25.05%),Pseudomonas aeruginosa(21.86%)and Klebsiella pneumoniae(17.07%)were the three most common isolates.A.baumannii presented the highest susceptibility to colistin(86.86%)and the highest resistance to piperacillin(96.41%),and P.aeruginosa showed the highest susceptibility to colistin(92.27%)and the highest resistance to tigecycline(85.73%).Among all Enserobacteriaceae isolates,Escherichia coli presented the highest susceptibility to colistin(98.09%)and the highest resistance to cefuroxime(66.70%),K.pneumoniae showed the highest susceptibility to colistin(81.17%)and the highest resistance to cefotaxime(80.64%),Serratia spp.presented the highest susceptibility to amikacin(97.07%)and the highest resistance to cefuroxime(52.33%),and Proteus spp.showed the highest susceptibility to meropenem(94.93%)and the highest resistance to trimethoprim/sulfamethoxazole(70.28%),while Citrobacter spp.presented the highest susceptibility to amikacin(100.00%)and the highest resistance to cefuroxime(49.81%).Among the Gram-positive bacterial isolates,Staphylococcus aureus and coagulase-negative staphylococci presented a 100.00%susceptibility to vancomycin,and Enterococcus faecalis showed a 100.00%susceptibility to linezolid,while E.faecium presented a 100.00%susceptibility to levofloxacin.In addition,Haemophilus influenza showed the highest susceptibility to chloramphenicol(96.9%)and the highest resistance to penicillin(52.94%),and Moraxella catarrhalis presented the highest susceptibility to levofloxacin(98.33%)and the highest resistance to amikacin(70.90%).Conclusion Gram-negative bacteria are major pathogens for lower respiratory tract infections among patients in department of respiratory medicine,and A.baumannii,P.aeruginosa and K.pneumoniae are the three most frequent bacterial isolates.A.baumannii shows a high level of resistance to common antibiotics,while a less than 50.00%rate of resistance to common antibiotics is tested in S.pneumoniae.
作者
毛成晔
范庭涛
蔡兴旺
周洋洋
MAO Cheng-ye;FAN Ting-tao;CAI Xing-wang;ZHOU Yang-yang(Department of Respiratory Medicine,Sanming First Hospital,The Affiliated Hospital of Fujian Medical University,Sanming 365000,Fujian,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2022年第11期1319-1323,共5页
Journal of Pathogen Biology
基金
福建省自然科学基金项目(No.2021J011389)。
关键词
病原谱
抗生素耐药性
下呼吸道感染
呼吸内科
Pathogenic spectrum
Antibiotic resistance
Lower respiratory tract infection
department of respiratory medicine
