广州地区慢性阻塞性肺病患者呼吸道绿脓杆菌感染及抗菌治疗

PSEUDOMONAS AERUGINOSA INFECTION IN COPD AND ITS MANAGEMENT IN GUANGZHOU AREA

采用作者设计的“全痰系列分离法”分别用七种培养基对146例慢性阻塞性肺病(COPD)急性发作患者痰液进行细菌学分离培养,较多见的细菌学分别为厌氧菌、肺炎链球菌、克雷白氏菌、绿脓杆菌及大肠杆菌等.其中绿脓杆菌占全部病原菌总数的10.8%.第三代头孢霉素尤以头孢噻甲羧肟(ceftaizdime)对绿脓杆菌抗菌作用较强.

A method of whole sputum cultivation' was established to determinethe pathogens in pulmonary infections.Fresh sputum washed with saline was digested in1.8% of ammonium chloride and then cultured in seven culture media (blood agar, choco-late, anaerobic, Bordet Sabouraud, Salmonella and Shigella (SS) and Lwensteins). Meanwhile, specimens of patients saliva were also cultured for pathogens usingthe same procedure. Definite pathogens were ascertained by those fulfilling one of the fol-lowing criteria: 1) pure culture of a bacterium with the concentration of 10~7/ ml; 2) those bacteriawith the concentration or 10~8/ ml and 3) those bacteria with the concentration in sputum100 times higher than that in saliva. 302 cultivations of sputum were performed in 146 chronic obstructive pulmonary dise-ase (COPD) patients (M 100, F46, 57±11 years) with acute onset or respiratory infec-tion. There were 277 strains of 28 pathogens, commonly being Anacrobic bacilli (27.5%).pneumococci (9.4%) Haemophilus influenzae (9.4%), Strep. hemolyticus (8.4%),Klebsiella pneumoninc (8.4%) and Pseudomonas aeruginosa (8.9%). Strains ofPs.aeruginosa were obtained from those who received long term routin antibiotics admini-stration and often revealed pure culture in their sputum. sensitiorty of bacteria to antibioticswas performed in 32 strains or Ps.aeruginosa separated from patients sputum as well as 11standard strains or Ps.aeruginosa.The percentages of highly sensitive strains to various an-tibiotics were as follows: cefamandole%, cefsulodin 40%, tobramycin 48%,carbenicillin 35%, ceftriaxone 44%, cefoperazone 53%, and ceftazidime 79%. Ceftazidime (lg Ⅳ q8hx 10-14 days) was administered in 14 COPD patients withPs. aeruginosa infection. 12 cases (85.7%) showed negative culture in sputum and clinicalcure after one course of ceftazidime therapy.