慢性阻塞性肺疾病急性加重期病原学及细菌耐药性分析

Etiology and drug resistance analysis in acute exacerbation of chronic obstructive pulmonary disease

目的:探讨慢性阻塞性肺疾病急性加重期病原学特点及细菌耐药情况,为临床合理使用抗生素提供科学依据。方法:回顾性分析我院呼吸内科和老年学科2008年1月-2009年1月563例慢性阻塞性肺疾病(急性加重期)住院患者痰培养及药敏试验结果。结果:563例患者中检出阳性结果205例,检出率为36.41%。其中G+菌46例、G-菌119例、真菌40例。G+菌以金黄色葡萄球菌最多(14例),其次为表皮葡萄球菌和草绿色链球菌;G-菌以铜绿假单胞菌最多(37例),其次为克雷伯菌;真菌以白色念珠菌最多(20例)。G-杆菌对氨苄西林、哌拉西林、头孢唑啉、复方新诺明耐药严重,对亚胺培南、含β-内酰胺酶抑制剂的联合制剂较敏感。金黄色葡萄球菌对多种抗生素严重耐药,对万古霉素、亚胺培南较敏感。真菌对氟康唑敏感占50.81%,对伊曲康唑敏感占30.12%,对酮康唑敏感占30.83%,对5-氟胞嘧啶敏感占10.74%。结论:慢性阻塞性肺疾病急性加重期以G-为主,真菌感染有增多趋势,病原菌呈现多重耐药现象。

Objective：To study the characteristics of the etiology and drug resistance in acute exacerbation of chronic obstructive pulmonary disease patients,to provide a favorable clinical basis for rational drug use. Methods：563 cases diagnosed as AECOPD patients from January 2008 to January 2009 in Respiratory and Geriatric Medicine departments at our hospital were retrospectively analyzed. Results：of their sputum samples for culture and sensitivity test were collected and analyzed. Results 205 cases（36.41%） out of 563 cases of patients were tested positive,among which 46 cases（22.44%） were detected with G＋ bacteria,119 with G-bacteria（58.05%） ,40 with fungal（19.51%） . Most of the G＋ bacteria infection were Staphylococcus aurous（14 cases） ,followed by Staphylococcus epidermidis and Streptococcus viridians;Most of the G-bacteria infection were Pseudomonas（37 cases） ,followed by Klebsiella. Most of the fungal infection were Candida albicans（20 cases） . G-bacteria showed a strong drug resistance to ampicillin,piperacillin,cefazolin and cotrimoxazole,and a strong sensitivity to imipenem and β-lactamase inhibitor. Staphylococcus aureus were seriously resistant to multiple antibiotics and sensitive to vancomycin and imipenem. Fungal drug sensitivity test showed that 50.81% of them were sensitive to fluconazole,30.12% sensitive to Itraconazole-,30.83% of them sensitive to ketoconazole,and 10.74% of them sensitive to 5-fluorocytosine. Conclusion：G-bacteria in AECOPD patients are predominant. There is a growing trend in fungal infections. The pathogenic bacteria showed a multi-drug resistance.