慢性阻塞性肺疾病急性发作期患者病原菌分布与耐药分析

Analysis on pathogenic distribution and drug-resistance in patients with acute exacerbation of chronic obstructive pulmonary disease

目的了解某院慢性阻塞性肺疾病急性加重期（AECOPD）患者痰培养病原菌分布及药敏情况，指导临床合理应用抗菌药物。方法对该院2004-2006年住院的454例AECOPD患者痰培养及药敏结果进行分析。结果痰培养分离出病原菌332株，其中医院感染菌181株，社区感染菌151株，以革兰阴性（G^-）菌为主（65．36％）。医院感染菌中，G^-菌占71．27%（129株），革兰阳性（G^＋）菌占16．57％（30株），真菌占12．16％（22株）；社区感染菌中，G^-菌占58．28％（88株），G^＋菌占39．73％（60株），真菌占1．99％（3株）；上述菌种医院感染株与社区感染株比较，差异均具显著性（P为0．000-0．013）。医院感染菌对各种抗菌药物的耐药率多高于社区感染菌（P〈0．05或P〈0．01）。结论AECOPD患者下呼吸道感染病原菌以G菌为主，医院感染者更加明显，医院真菌感染率亦高于社区感染；与社区感染菌相比，医院感染菌耐药性更严重。临床医生应重视病原菌培养和药敏试验，合理用药，以减少细菌耐药性产生及二重感染的发生。

Objective To investigate the distribution and drug-resistance of pathogens isolated from patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）, so as to guide the rational antimicrobial application in clinic. Methods Sputum culture and antimicrobial susceptibility results of 454 patients with AECOPD who were hospitalized in a hospital from 2004-2006 were analysed. Results Three hundred and thirty-two pathogenic strains were isolated, 181 strains were nosocomial infection strains, 151 were community infection strains, the main bacteria were gram-nagetive bacteria （65.36%）. Among nosocomial infection strains, gram-negative, grampositive strains and fungi accounted for 71.27%（129 strains）, 16. 57% （30 strains ） and 12. 16% （22 strains ） respectively） among community infection strains, gramnegative, gram-positive strains and fungi accounted for 58. 28 % （88 strains）, 39. 73 % （60 strains ） and 1.99% （3 strains ） respectively） there was significant difference between nosocomial and community strains （P = 0. 000-0. 013）. The drug-resistant rates of nosocomial strains were higher than that of community infection strains （P〈0. 05 or P〈0. 01）. Conclusion The main pathogens in lower respiratory tract infection in AECOPD patients are gram-negative strains, especially in patients with nosocomial infection, nosocomial fungi infection rate is also higher than that of community infection rate. the resistance of antimicrobial agents in nosocomial infection is more serious than that of community infection. Clinicians should pay attention to pathogenic culture and antimicrobial susceptibility test and rational antimicrobial application, so as to reduce the emergence of drug resistance and double infection.