COPD急性加重机械通气患者下呼吸道病原菌分布和耐药现状

Distribution and Antibiotic Resistance of Isolates from Lower Respiratory Tract in Mechanically Ventilated Patients with COPD

目的调查行机械通气的慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道标本主要病原菌的构成和耐药情况,为临床治疗提供依据。方法将2008年1月至2009年12月呼吸ICU内行机械通气的AECOPD患者分为社区感染组及医院感染组。经支气管镜防污染毛刷取得患者下呼吸道标本进行病原菌分离培养鉴定及药敏试验。结果共纳入134例,其中社区感染组75例,医院感染组59例。医院感染组病原菌检出率显著高于社区感染组(81.4%比54.7%,P<0.01)。社区感染组检出G-杆菌27株(55.1%),G+球菌14株(28.6%),真菌8株(16.3%)。医院感染组检出G-杆菌34株(61.8%),G+球菌12株(21.8%),真菌9株(16.4%)。医院感染组与社区感染组菌种构成无显著差异(P>0.05)。医院感染组产超广谱β-内酰胺酶(ESBLs)细菌检出率高于社区感染组(58.8%比37%,P<0.05)。医院感染组菌株对主要抗生素耐药率高于社区感染组。结论机械通气AECOPD患者下呼吸道病原菌耐药现象严重,医院感染组较社区感染组更严重。真菌感染及耐药性增多提示临床医师须重视合理用药,坚持细菌耐药性监测及加强防控。

Objective To investigate the distribution and antibiotic resistance of pathogens isolated from lower respiratory tract in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Methods The patients with AECOPD,who were hospitalized in RICU from January 2008 to November 2009,were divided into a community infection group and a nosocomial infection group.Lower respiratory tract isolates were collected by bronchoscopic protected specimen brush for bacterial identification and susceptibility test.Results 134 cases were enrolled in the study,with 75 cases in the community infection group and 59 cases in the nosocomial infection group.The positive detection rate in the nosocomial infection group was significantly higher than that in the community infection group [81.4% （48/59） vs.54.7% （41/75）].In the community infection group,49 strains were isolated,in which gram-negative bacteria,gram-positive bacteria,and fungi accounted for 55.1%,28.6%,and 16.3%,respectively.In the nosocomial infection group,55 strains were isolated,in which gram-negative bacteria,gram-positive bacteria,and fungi accounted for 61.8%,21.8%,and 16.4%,respectively.There was no significant difference in the microbial distribution between the two groups（P0.05）.The detection rate of ESBLs producing strains in the nosocomial infection group was significantly higher than that in the community infection group （58.8% vs.37%）.The resistance rates in the nosocomial groups were higher than those in the community infection group.Conclusions Antibiotic resistance is serious in mechanically ventilated patients with AECOPD,especially in the nosocomial infection patients.The increased fungi infection and drug resistance warrant clinicians to pay more attention to rational use of antibiotics,and take effective control measures.