慢性阻塞性肺病的病原学及细菌耐药性分析

Etiology and drug resistance analysis of COPD sufferer

目的探讨慢性阻塞性肺病(COPD)患者感染的病原菌情况与院内的耐药性比较分析。方法采用VITEK全自动微生物鉴定系统鉴定病原菌,按美国临床实验室标准化委员会的纸片扩散法进行耐药性、超广谱β-内酰胺酶(ESBLs)及耐甲氧西林葡萄球菌(MRS)检测,统计分析采用WHONET5.4软件进行。结果培养阳性患者中革兰阴性菌感染占73.7%(肺炎克雷伯菌、绿脓假单胞菌及大肠埃希菌占前3位),革兰阳性菌感染占26.3%,且革兰阴性菌耐药率明显高于全院患者;ESBLs、MRS检出率分别为78.5%、76.1%,Fisher确切概率计算法革兰阴性菌的耐药率明显高于全院平均水平。结论COPD患者中革兰阴性菌占优势,且革兰阴性菌耐药率明显高于全院患者,ESBLs、MRS检出率高,提示感染患者细菌的高耐药性。

Objective To study the etiology of chronic obstructive pulmonary disease （COPD） and to compare its drug resistance with that in the whole hospital, Methods To identify the bacterium by VITEK, and to detect the drug sensitivity, ESBLs and MRS with K-B method according to NCCLS. The statistic analysis was performed with WHONET 5.4. Results In positive samples, Gram-negative bacteria accounted for 73.7% （Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were responsible for the first, second and third）, Gram-positive bacteria accounted for 26.3 %, ESBLs and MRS were 78.5 %, 76.1 % respectively. Fisher probabilities showed the drug resistance ratio of Gram-negative bacteria was higher than that of the whole hospital evidently. Conclusion In COPD sufferer, Gram-negative bacteria are predominant and the drug resistance ratio is higher than that of the whole hospital. High detection rate of ESBLs and MRS means the high drug resistance of the bacteria.