俞国峰 严一核 应利君

[摘要] 目的 分析重症医学科肺部感染患者肺泡灌洗液病原菌分布及其耐药情况，以指导临床抗菌药物使用。方法 回顾性分析2016年6月～2017年5月重症医学科肺部感染患者肺泡灌洗液分离的细菌培养结果及耐药性分析。采用WHONET5.4软件进行药敏结果统计。 结果 共分离出非重复菌株137株，革兰阴性菌共122株，占比89.1%，以鲍曼不动杆、铜绿假单胞菌、肺炎克雷伯菌为主，分别占24.1%、21.9%、14.6%。革兰阳性菌菌株共15株，占比10.9%，以金黄色葡萄球菌为主，占比7.3%，对万古霉素及替考拉宁敏感率为100.0%。 结论 重症医学科肺部感染患者肺泡灌洗液的主要病原菌为革兰阴性菌，细菌多重耐药现象明显，开展监测及合理用药是控制感染和耐药菌出现的关键。

[关键词] 重症医学科；肺泡灌洗液；病原菌；耐药性

[中图分类号] R563.1 [文献标识码] B [文章编号] 1673-9701（2018）07-0089-04

[Abstract] Objective To analyze the distribution and drug resistance of alveolar lavage fluid in patients with pulmonary infection in the Department of Critical Care Medicine to guide the clinical use of antibacterial drugs. Methods The bacterial culture results and antibiotic resistance of pulmonary alveolar lavage fluid isolated from patients with pulmonary infection in the Department of Critical Care Medicine from June 2016 to May 2017 were retrospectively analyzed. WHONET5.4 software was used for drug susceptibility results statistics. Results A total of 137 non-repetitive strains were isolated， of which 122 strains were Gram-negative bacteria， accounting for 89.1%， mainly including Bauman immobilized rods， Pseudomonas aeruginosa and Klebsiella pneumoniae， accounting for 24.1%， 21.9% and 14.6%， respectively. There were a total of 15 strains of Gram-positive bacteria（10.9%）， mainly for Staphylococcus aureus， accounting for 7.3%， with 100.0% sensitive rate to vancomycin and teicoplanin. Conclusion The main pathogen of pulmonary alveolar lavage fluid in patients with pulmonary infection in Department of Intensive Care Unit is Gram-negative bacteria. Bacterial multi-drug resistance is obvious. Monitoring and rational drug use is the key to controlling infection and emergence of drug-resistant bacteria.

[Key words] Department of Intensive Care Unit； Alveolar lavage fluid； Pathogen； Drug resistance

肺部感染是重症医学科常见和主要疾病之一，也是导致危重症患者死亡的原因之一[1]。目前重症医学科肺部感染患者标本送检一般采用气管插管内吸出痰液送检，其标本易受污染，导致培养结果准确率不高，对临床参考价值有一定局限性。与之相比，利用纤维支气管镜肺段及亚肺段进行灌洗后收集到的支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF），由于不易受到上呼吸道杂菌的污染，具有直接、可靠、敏感和无创的优点，可提高病原菌诊断率，对重症肺部感染诊治具有较高的实用价值[2]。早期实行目标性抗感染治疗能改善重症感染患者的预后。由于重症患者基础疾病较多、免疫力低下、激素的使用、抗生素的廣泛使用、有创操作较多等，细菌多重耐药及泛耐药现象突出，增加了重症患者肺部感染的治疗难度[3]。……