慢性阻塞性肺病急性加重期患者下呼吸道分离病原菌特征^*

Characteristics of the Pathogenic Bacteria Isolated from the Lower Respiratory Tract of the Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

摘要

目的 分析从慢性阻塞性肺病急性加重期（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）患者下呼吸道分离病原菌的菌种分布及体外药物敏感性，为该类患者下呼吸道感染治疗提供参考。方法 纳入2015年1月–2024年12月AECOPD疑似发生下呼吸道感染的患者，回顾性收集从下呼吸道样本分离的病原菌菌种鉴定和体外药物敏感性检测结果，对比分析不同类型样本的病原菌检出率、菌种分布、主要菌种体外药物敏感性和多重耐药菌检出情况。采用WHONET 5.6和SPSS 26.0软件分析数据。结果 纳入的3 861例患者送检下呼吸道样本25 253份，痰液、气道分泌物和肺泡灌洗液的病原菌检出率分别为27.2%（6 463/23 722）、33.5%（135/403）和48.9%（551/1 128），检出率差异有统计学意义（ P<0.001）。共分离到非重复菌株3 824株，门急诊患者和住院患者来源的细菌数量比为1∶6，重症监护病房和其他病房来源的细菌数量比为1∶7。分离株以革兰阴性菌为主（93.1%），鲍曼不动杆菌复合群检出率最高（23.7%），其次为铜绿假单胞菌（21.4%）、肺炎克雷伯菌（12.6%）、嗜麦芽窄食单胞菌（11.7%）和大肠埃希菌（4.6%）；革兰阳性菌占比为6.9%，以金黄色葡萄球菌（3.2%）为主；苛养菌占比为6.4%，包括流感嗜血杆菌（3.9%）、卡他莫拉菌（1.6%）和肺炎链球菌（0.9%）。耐甲氧西林金黄色葡萄球菌检出率为41.8%（51/122），耐碳青霉烯类的大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌复合群和铜绿假单胞菌的检出率依次为12.0%（21/175）、18.1%（87/480）、69.9%（635/908）和29.3%（240/819）。与痰样本相比，非痰样本的多重耐药菌检出率更高（P<0.01）。结论 AECOPD患者下呼吸道检出病原菌中绝大多数为革兰阴性菌，苛养菌检出率较低，非痰样本的多重耐药菌检出率较高。

Abstract

Objective To analyze the species distribution and in vitro susceptibility of pathogenic bacteria isolated from the lower respiratory tract of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to provide guidance for the treatment of pulmonary infections in this kind of patients. Methods The AECOPD patients with suspected lower respiratory tract sample infection from January 2015 to December 2024 were included. The data of species identification and in vitro drug susceptibility testing results of pathogenic bacteria isolated from the lower respiratory tract were retrospectively collected. The detection rate, species distribution, in vitro susceptibility of predominant species, and ratios of multidrug-resistant (MDR) bacteria were compared among different sample types. Data were analyzed using WHONET 5.6 and SPSS 26.0 software. Results A total of 25 253 lower respiratory tract samples from 3 861 patients were included. The pathogen detection rates in sputum, aspirates and bronchoalveolar lavage fluids were 27.2% (6 463/23 722), 33.5% (135/403), and 48.9% (551/1 128), respectively, with a statistically significant difference of detection rate ( P < 0.001). Among the 3,824 non-repetitive strains, the ratio of the isolates recovered from outpatients and emergency patients to those from inpatients is 1∶6, and the ratio of the isolates from intensive care unit patients to those from other units is 1∶7. Gram-negative bacteria accounted for 93.1%, with the predominant species including Acinetobacter baumannii complex (23.7%), Pseudomonas aeruginosa (21.4%), Klebsiella pneumoniae (12.6%), Stenotrophomonas maltophilia (11.7%), and Escherichia coli (4.6%). Gram-positive bacteria accounted for 6.9%, with Staphylococcus aureus was the most common species (3.2%). Fastidious bacteria accounted for 6.4%, including Haemophilus influenzae (3.9%), Moraxella catarrhalis (1.6%), and Streptococcus pneumoniae (0.9%). The detection rate of methicillin-resistant S. aureus (MRSA) was 41.8%. The detection rates of carbapenem-resistant E. coli, K. pneumoniae, A. baumannii complex, and P. aeruginosa were 12.0% (21/175), 18.1% (87/480), 69.9% (635/908), and 29.3% (240/819), respectively. Compared with sputum, non-sputum specimens showed a higher detection rate of MDR bacteria (P < 0.01). Conclusion Gram-negative bacteria were the predominant pathogenic bacteria detected from the low respiratory tract of AECOPD patients, with a low isolation rate of fastidious bacteria. Non-sputum samples exhibited a higher detection rate of MDR bacteria.

关键词

慢性阻塞性肺病急性加重期 / 病原菌 / 体外药物敏感性

Key words

Acute exacerbation of chronic obstructive pulmonary disease / Pathogenic bacteria / In vitro drug susceptibility

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基金资助

*国家科技四大慢病重大专项(2024ZD0533100/2024ZD0533106)

四川省科学技术厅重点研发项目(2024YFFK0225)