目的了解全国支气管肺泡灌洗液(BALF)标本来源细菌的耐药性变迁。方法从2014—2019年全国细菌耐药监测网(CARSS)监测报告中提取BALF标本相关数据,并用WHONET 5.6软件进行耐药性分析。结果2014—2019年BALF标本中共检出细菌140321株,检出细菌排在前5位的分别是铜绿假单胞菌(19.1%)、鲍曼不动杆菌(16.6%)、肺炎克雷伯菌(16.6%)、金黄色葡萄球菌(7.8%)和肺炎链球菌(6.2%)。药敏数据显示,MRSA 6年间的检出率分别为52.3%、55.5%、51.4%、42.8%、40.6%和37.9%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的金黄色葡萄球菌。肺炎链球菌对青霉素的耐药率总体在1.0%~4.4%,且青霉素非敏感肺炎链球菌(PNSP)呈逐年下降趋势;除复方磺胺甲口恶唑外,肺炎克雷伯菌对其他抗菌药物的耐药性逐年上升,尤其对于碳青霉烯类抗生素,耐药性明显高于大肠埃希菌和阴沟肠杆菌。非发酵菌中铜绿假单胞菌的耐药率相对较低,大多在30%以下;鲍曼不动杆菌对所有受试抗菌药物的耐药率总体变化不大,但其对大部分抗菌药物的耐药率相对较高,大部分超过50%。结论中国BALF标本分离病原体主要以革兰阴性杆菌为主,且耐药现状严重。呼吁临床多送检高质量BALF标本,重视病原学检测,根据相应的耐药监测资料合理使用抗菌药物。
Objective To investigate the changes of antimicrobial resistance of bacteria from bronchoalveolar lavage fluid(BALF)specimens in China.Methods Data of BALF specimens were extracted from China Antimicrobial Resistance Surveillance System(CARSS)surveillance report in 2014-2019,antimicrobial resistance was analyzed by WHONET 5.6 software.Results From 2014 to 2019,a total of 140321 strains of bacteria were isolated from BALF specimens,the top 5 bacteria were Pseudomonas aeruginosa(19.1%),Acinetobacter baumannii(16.6%),Klebsiella pneumoniae(16.6%),Staphylococcus aureus(7.8%)and Streptococcus pneumoniae(6.2%).Antimicrobial susceptibility data of 6 years showed that isolation rates of methicillin-resistant Staphylococcus aureus(MRSA)were 52.3%,55.5%,51.4%,42.8%,40.6%and 37.9%respectively,vancomycin-,teicoplanin-and line-zolid-resistant Staphylococcus aureus were not found.The overall resistance rates of Streptococcus pneumoniae to penicillin were 1.0%-4.4%,penicillin-nonsusceptible Streptococcus pneumonia(PNSP)showed a downward trend year by year;except for compound sulfamethoxazole,resistance of Klebsiella pneumoniae to other antimicrobial agents increased year by year,especially for carbapenems,resistance was significantly higher than that of Esche-richia coli and Enterobacter cloacae.Among non-fermentative bacteria,resistance rates of Pseudomonas aeruginosa were relatively low,most were below 30%;resistance rates of Acinetobacter baumannii to all tested antimicrobial agents didn’t change much generally,but its resistance rates to most antimicrobial agents were relatively high,most were more than 50%.Conclusion Gram-negative bacilli are the main pathogens isolated from BALF specimens in China,and antimicrobial resistance is serious.It is suggested that high-quality BALF specimens should be sent for clinical examination,pathogen detection should be paid attention to,and antimicrobial agents should be used rationa-lly according to the corresponding antimicrobial resistance surveillance data.
Chinese Journal of Infection Control
bronchoalveolar lavage fluid
China Antimicrobial Resistance Surveillance System