189例老年慢性阻塞性肺病发作期痰菌培养及药敏分析

Analysis of Bacteriological Culture & Drug Sensitivity in 189 Patients with Chronic Obstructive Pulmonary Disease inAcute Exacerbation Stage

目的:分析老年慢性阻塞性肺病急性发作期(AECOPD)患者痰菌培养及耐药情况,为临床选择药物提供参考。方法:选取合格标本按《全国临床检验操作规程》第3版操作方法,常规分离培养。采用Vitek-32自动微生物鉴定仪鉴定。药敏试验采用MIC定量药敏检测。结果:189例老年AECOPD患者中,经痰菌培养阳性率为52.91%(100/189)。100例阳性患者中痰菌培养菌株102株,其中革兰阳性(G+)菌15.69%(16/102),革兰阴性(G-)菌62.75%(64/102),真菌22株21.56%(22/102)。G-菌中铜绿假单胞菌>肺炎克雷伯菌>大肠埃希菌,G+菌中以金黄色葡萄球菌、链球菌为主,真菌中主要为白色念珠菌。结论:G-菌对第3代头孢菌素、β内酰胺酶抑制剂及亚胺培南、美罗-培南等抗生素敏感,G+菌对青霉素耐药率高,未发现对万古霉素、替考拉宁耐药菌株。提示临床治疗中应联合应用抗感染药物,同时加强综合治疗。

Objective： To investigate the distribution and resistance to antibiotics of elderly patients with chronic obstructive pulmonary disease in acute exacerbation stage and to provide the reference for clinic. Methods： According to the book of national clinical test routine practice, qualified sputum specimen was chosen, routinely isolated and cultured. Sputum bacteria were identified by Vitek-32 microbial detection instrument. Drug sensitive test was MIC quantitative approach. Results： In 189 patients, positive result in spotum bacteria culture was 52.91%（100/189）, and 102 strains were identified： 15.69%（16/102） was Gram-positive cocci, 62-75%（64/102）was Gram-negative bacilli, and 21.57%（22/102）was fungi. In Gram-negative bacilli（GNB）, Paeudomonas aeruginose 〉 Klebsiella 〉 Escherichia. In Gram-positive cocci, the most was Staphyloccus aureus and Streptococcus pneumoniae. The fungi affection was Candida albicans. The drug sensitivity showed that the most of GNB were sensitive to ceftazidime, enzyme inhibitor, imipenem and meropenem and so on. Gram-positive cocci showed high resistance to penicillin, but no resistance to vancomycin and teicoplanin was found. Conclusion： The drug sensitivity showed that the most of GNB were sensitive to ceftazidime, enzyme inhibitor, imipenem, meropenem and so on. Gram-positive cocci showed high resistance to penicillin, but was found no resistance to vancomycin and teicoplanin. These hinted that in clinic we had better combine the multiple antibiotics, and it may strengthen the relief and control the pains of patients by using multiphy therapy.