慢性阻塞性肺病急性加重期呼吸道病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in respiratory tract of patients with acute explosion chronic obstructive pulmonary disease

目的 :总结我院慢性阻塞性肺病急性加重期呼吸道感染病原菌分布和耐药性特点 ,指导抗生素应用 .方法 :对我院 2 0 0 2 0 1/ 2 0 0 4 0 5呼吸病房及干部病房收治的 2 4 0例AE COPD患者行痰液细菌培养 ,药敏采用纸片扩散法 .结果 :2 4 0例AECOPD患者痰细菌培养分离出 114株致病菌 ,以革兰阴性杆菌占首位 (6 6 .7% ) ,革兰阳性球菌第 2位 (2 4 .6 % ) ,真菌第 3位 (7.0 % ) .革兰阴性杆菌中以假单胞菌属 (2 8.1% )、流感嗜血杆菌 (15 .8% )、肠杆菌属 (12 .3% )、肺炎克雷伯杆菌 (8.8% )为主要致病菌 .革兰阳性球菌中以金黄色葡萄球菌 (12 .3% )、肺炎链球菌 (7.0 % )、表皮葡萄球菌 (5 .3% )为主要致病菌 .药敏发现 ,替卡西林 /克拉维酸、亚胺培南、头孢他啶、哌拉西林、丁胺卡那对大部分革兰阴性杆菌有较好敏感性 ,亚胺培南、头孢他啶、万古霉素对大部分革兰阳性球菌有较好敏感性 .结论 :AECOPD下呼吸道致病菌以革兰阴性杆菌为主 ,且耐药率较高 .经验用药宜选头孢 3,4代或含有 β 内酰胺酶抑制剂的抗生素 .

AIM: To analyze the distribution of pathogens in respiratory tract and their drug resistance in the patients with acute explosion chronic obstructive pulmonary disease (AECOPD) for a better use of antibiotics in treatment. METHODS: The sputum samples of 240 AECOPD patients from January 2002 to May 2004 were collected from our hospital and the pathogen's species in all samples were tested. The drug sensitivity was determined by slip diffusion method. RESULTS: 114 strains of pathogens were found in all sputum samples. 66.7% of them were Gram-negative, 24.6% were Gram-positive and 7.0% were epiphytes. Among the Gram-negative bacillis, the main pathogens included Pseudomonas (28.1%), Haemophilus influenza (15.8%), enteric bacilli (12.3%), and Klebsiella pneumoniae (8.8%). Among the Gram-positive coccis, the main pathogens included Staphyloccus aureus (12.3%), Pneumococcus (7.0%) and Staphyloccus epidermindis (5.3%). The results of drug sensitivity test showed that most of the Gram-negative bacillis were more sensitive to ticarcilli/clavulanate potassium, imipenem, ceftazidime, piperacillin and amikacin, and that most of the Gram-positive coccis were more sensitive to imipenem, ceftazidime and vancomycin. CONCLUSION: Gram-negative bacillus are predominant in lower respiratory tract in AECOPD patients with higher frequency of drug resistance. The 3rd or 4th generation of cephalosporins and some antibiotics with the capability of inhibiting ESBLS are recommended in clinical application.