慢性阻塞性肺疾病急性加重患者下呼吸道病原菌分析

Analysis on the pathogens in lower respiratory tracts of patients with acute exacerbation of chronic obstructive pulmonary disease

目的了解慢性阻塞性肺疾病急性加重患者(AECOPD)下呼吸道感染病原菌的特点及耐药情况,为临床合理选择抗菌药物提供借鉴。方法取诸暨市人民医院2005年1月至2009年12月住院的273例AECOPD患者的下呼吸道痰标本及纤支镜刷取分泌物进行培养、鉴定、药敏,并对结果进行分析。结果 273例AECOPD患者中有225例患者分离到病原菌,分离病原菌282株。病原菌中革兰阴性杆菌最多,占46.8%,依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌等;革兰阳性球菌占18.4%,以金黄色葡萄球菌最多,肠球菌、肺炎链球菌次之;真菌占20.9%;流感嗜血杆菌占13.8%。药敏结果显示阴性杆菌对美罗培南敏感率最好,其次为亚胺培南、哌拉西林-他唑巴坦。结论 AECOPD患者下呼吸道病原菌以革兰阴性杆菌为主,耐药现象明显,流感嗜血杆菌已经成为AECOPD患者重要的致病菌之一。

Objective To investigate the distribution and antibiotic resistance of bacterial pathogens in lower respiratory tracts of patients with acute exacerbation of chronic obstructive pulmonary diseases（ AECOPD）. Method Sputum and tracheal secretions were collected by bronchoscopy in 273 patients with AECOPD who were hospitalized during the period from January 2005 to December 2009 in our hospital. The results of pathogen identification and susceptibility testing were analyzed. Result A total of 282 strains of microorganisms were isolated from 225 of the 273 patients. Gram-negative bacillus accounted for 46.8% ,including P. aeruginosa, IE pneumoniae and Acinetobacter spp; Gram-positive cocci accounted for 18.4% ,including S. aureus, S. pneumoniae and Enterococcus spp; Fungi accounted for 20.9% ; H. influenzae accounted for 13.8%. Susceptibility testing results showed that gram-negative bacillus had the highest sensitive rate to Meropenem, followed by Imipenem and Piperacillin-tazobactan. Conclusion The main pathogens in lower respiratory tract infection in AECOPD patients are gram-negative bacillus;it is highly resistant to antibiotics. H. influenzae is one of the most important pathogens in AECOPD.