老年慢性阻塞性肺疾病患者并发医院内获得性肺炎常见病原菌及其耐药性分析

Distribution and antmicrobial resistance of pathogenic strains from sputum sample of patients of hospital acquired pneumonia with chronic obstructive pulmonary disease

目的了解老年慢性阻塞性肺疾病(COPD)患者并发医院获得性肺炎(HAP)常见病原菌及其耐药性的情况,为临床治疗提供参考。方法对我科86例老年COPD患者并发HAP的患者的痰合格标本进行培养及药敏试验,对结果进行统计。结果86例患者痰培养阳性者共70例,共获得致病细菌株78株,革兰阴性杆菌占60%,革兰阳性球菌占39.7%,且MRSA(+)。其中铜绿假单胞菌最多(25.6%),其次金黄色葡萄球菌占19.2%。革兰阴性杆菌对三代头孢霉素耐药严重,对头孢他定、头孢哌酮/舒巴坦或碳青霉烯类的抗生素较敏感。而革兰阳性菌对青霉素几乎全部耐药,未发现对万古霉素耐药。结论老年COPD患者并发医院获得性肺炎的患者常见致病菌以革兰阴性杆菌多见,且耐药严重,临床选择抗生素时应加慎重。

Objective To investigate the distribution and resistance to antibiotics of patients of hospital acquired pneumonia（HAP）with chronic obstructive pulmonary disease（COPD）.Methods Bacteria isolates and their resistance to antibiotics was take on sputum specimen from 86 patients of HAP with COPD.Results 78 strains were identified from 86 sputum specimen：60.03% was gram-negative bacilli,39.7% Gram-positive coccid,the out standing pathogens are pseudomonas aeruginosa（25.6%）and staphylococcus aureus pneumonia（19.2%）and MRSA（＋）.The results revealed that Gram-negative bacilli decreased susceptibility to third generation cephalosporins,but were sensiti to imipenem,and in some what lesser eatent to ceftazidime,cefoperazone-sulbaetam、Gram-prsitive cocci showed hight resistance to penicillin while found no resistance to vancomycin.Conclusion The mam isolated pathogens from afed patients of HAP with COPD are disease are Gram-negative bacilli,and amtimicrobiac resistance is very common.