作者：雷莉莉1 ，徐春华 2 ，李春梅 3

单位：

1.210029 江苏省南京市，东南大学附属南京市胸科医院感染管理科　；2.210029 江苏省南京市，东南大学附属南京市胸科医院内镜中心　；3.210029 江苏省南京市，东南大学附属南京市胸科医院微生物室；通信作者：雷莉莉，E-mail：lllecho@sina.com

关键词：

肺疾病；支气管肺泡灌洗液；细菌；耐药

Keywords：

Lung disease；Bronchoalveolar lavage fluid；Bacteria；Mycobacterium

CLC：

R 563

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.018

Funds：

摘要：

目的　探讨 2014—2018 年支气管镜肺泡灌洗液主要病原菌及其耐药性。方法　选取 2014—2018 年在东南大学附属南京市胸科医院住院的感染患者 690 例，均采用支气管镜检查，并对肺泡灌洗液进行细菌培养及药敏试验进行分析。结果　2014—2018 年支气管镜肺泡灌洗液检出主要病原菌 690 株，包括革兰阴性菌 393 株（56.96%），革兰阳性菌 86 株（12.46%），真菌 211 株（30.58%）。2014—2018 年主要革兰阴性菌中肺炎克雷伯菌对哌拉西林耐药率较高，为 37.06%；铜绿假单胞菌对常见抗生素敏感，耐药率均低于 30.00%；大肠埃希菌对头包他啶、环丙沙星、哌拉西林、左氧氟沙星耐药率较高，均超过 30.00%。2014—2018 年表皮葡萄球菌、溶血葡萄球菌及耐甲氧西林金黄色葡萄球菌（MRSA）均未见对莫西沙星、达托霉素、万古霉素、利奈唑胺耐药，其中表皮葡萄球菌对头孢曲松、复方新诺明、利福平、红霉素、环丙沙星耐药率均超过75.00%，溶血葡萄球菌对头孢曲松、复方新诺明、利福平、红霉素、环丙沙星耐药率均超过 50.00%，MRSA 对头孢曲松、复方新诺明、利福平、红霉素、四环素、环丙沙星耐药率均超过40.00%。2014—2018 年革兰阳性菌多重耐药率逐年降低，革兰阴性菌多重耐药率逐年升高（P<0.01）。结论　2014—2018 年革兰阴性菌包括肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌是下呼吸道疾病感染主要病原菌，且其耐药性逐年升高，故临床应根据药敏试验合理用药以降低耐药性。

Abstract：

Objective　To discuss main pathogenic bacteria of bronchoscopy alveolar lavage fluid and the drugresistance analysis from 2014 to 2018.Methods　690 infected patients were selected for bronchoscopy in Nanjing Chest HospitalAffiliated to Southeast University from 2014 to 2018，and they were tested with bronchoscopy，and the bacterial culture anddrug susceptibility test of alveolar lavage fluid were analyzed.Results　From 2014 to 2018，690 main pathogenic bacteria weredetected from bronchoscopy alveolar lavage fluid，including 393 Gram-negative bacteria （56.96%），86 Gram-positivebacteria （12.46%） and 211 fungi （30.58%）. From 2014 to 2018，in Gram-negative bacteria，klebsiella pneumoniaehad high resistance to piperacillin，resistance rate was 37.06%；the sensitive and resistance rate of pseudomonas aeruginosato common antibiotics were all lower than 30.00%；escherichia coli had high resistance to fortum，ciprofloxacin ，piperacillinand levofloxacin，resistance rate were all more than 30.00% .Staphylococcus epidermidis，staphylococcus haemolyticus andMRSA were not resistant to moxifloxacin，daptomycin，vancomycin，linezolid， resistance rate of staphylococcus epidermidisto ceftriaxone，selectrin，rifampicin，erythromycin， ciprofloxacin were more than 75.00%，resistance rate of staphylococcushaemolyticus to ceftriaxone，selectrin，rifampicin，erythromycin， ciprofloxacin were more than 50.0%， and resistancerate of MRSA to ceftriaxone，selectrin， rifampicin，erythromycin， tetracycline， ciprofloxacin were more than 40.0%.Themulti-drug resistance rate of Gram-positive bacteria decreased year by year from 2014 to 2018，and the multi-drug resistancerate of Gram-negative bacteria increased year by year（P<0.01）.Conclusion　Gram-negative bacteria including klebsiellapneumoniae，pseudomonas aeruginosa and escherichia coli are the main pathogens of lower respiratory tract disease infectionfrom 2014 to 2018，and with high drug resistance，so clinical drug use should be reasonable according to drug sensitivity test toreduce drug resistance.

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