慢性阻塞性肺疾病气道细菌感染的特性及耐药性分析

Characteristics of bacterial infections in airway of patients with chronic obstructive pulmonary diseases and drug resistance

目的分析慢性阻塞性肺疾病(COPD)患者气道细菌感染的特性及耐药性分析。方法选取2010年1月至2011年3月在医院确诊并有完整病原学资料的260例COPD住院患者进行痰标本采集,对痰标本进行细菌培养及耐药性分析。结果共检出细菌21种195株,总阳性率为75.0%,革兰阴性菌127株,占65.1%,革兰阳性菌68株,占34.9%;铜绿假单胞菌对加替沙星、头孢噻肟和环丙沙星的耐药性较强,分别为55.9%、47.5%、47.5%;大肠埃希菌对氨苄西林及环丙沙星的耐药性较强,分别为75.6%、84.4%;肺炎克雷伯菌对头孢噻肟及头孢他啶的耐药性较强,均87.0%;金黄色葡糖球菌和肠球菌属对除万古霉素外的其他抗菌药物的耐药性均较强。结论 COPD患者检出主要病原菌为革兰阴性杆菌,耐药性明显,临床医师应注意气道细菌感染的种类及耐药性分析,合理使用抗菌药物,及时调整治疗方案,利于尽早控制感染,降低患者的死亡率。

OBJECTIVE To analyze the characteristics of airway bacterial infections in airway of the patients with chronic obstructive pulmonary diseases（COPD） as well as the drug resistance.METHODS A total of 260 cases of COPD patients with complete etiology data who enrolled in the hospital from Jan 2010 to Mar 2011 were chosen,then the sputum specimens were collected for bacterial culture,the drug resistance was analyzed.RESULTS Totally 195 strains of bacteria in 21 species were examined with the total positive rate of 75.0%,there were 127（65.1%） strains of gram-negative bacteria and 68（34.9%） strains of gram-positive bacteria;the drug resistance of Pseudomonas aeruginosa to gatifloxacin,cefotaxime and ciprofloxacin was serious;the drug resistance of Escherichia coli to ampicillin and ciprofloxacin was serious;the drug resistance of Klebsiella pneumoniae to cefotaxime and ceftazidime was serious;the drug resistance of Staphylococcus aureus and Enterococci for to all the antibiotics except vancomycin was serious.CONCLUSION Gram-negative bacilli are the main pathogens isolated from COPD patients,the drug resistance is serious;the clinicians should pay attention to the species of bacteria causing airway infections and their drug resistance,reasonably use antibiotics and adjust the treatment in time so as to control the infections in early stage and reduce the mortality.