慢性阻塞性肺疾病急性加重期细菌分布及耐药性分析

Bacteriology and drug resistance analysis of patients with chronic obstructive pulmonary disease of acute exacerbation stage

目的 了解慢性阻塞性肺疾病急性加重期（AECOPD）患者下呼吸道感染中的细菌分布特点及耐药情况.方法 对我院2011年6月～2012年12月住院的152例AECOPD患者进行痰细菌培养、细菌药物敏感试验,根据肺功能第1秒用力呼气容积占预计值百分比（FEV1％pred）,将患者分为3组：Ⅰ组：（50％≤FEV1＜ 80％ pred）、Ⅱ组：（30％≤FEV1＜50％pred）、Ⅲ组：FEV1＜30％ pred;同时根据痰培养结果将感染细菌分为A（G＋菌）、B（除C以外的G-菌）、C（不动杆菌、肠杆菌及假单胞菌）、D（痰菌阴性）4类,比较3组患者痰细菌学分布特点及耐药情况.结果 152患者中70例患者痰培养阳性,阳性率46.1％,共分离出细菌84株,其中革兰氏阳性菌肺炎链球菌22株（26.2％）,金黄色葡萄6株（7.1％）,表皮葡萄球菌4株（4.8％）;革兰阴性菌铜绿假单胞菌10株（11.9％）,大肠埃希菌6株（7..1％）,肺炎克雷伯杆菌6株（7.1％）,部分致病菌呈多重耐药.Ⅰ组患者以痰菌阴性为主,Ⅲ组患者以耐药的A类菌及C类菌为主,各组患者细菌学分布差异有统计学意义（P＜0.05）.结论 AECOPD患者感染细菌种类以G-杆菌为主,耐药率高,感染细菌种类与COPD严重程度有密切关系,肺功能越差,耐药的G＋球菌、肠杆菌、铜绿假单胞菌分离率越高.

[Abstract] Objective To explore characteristics of bacteriology and drug resistance in patients with chronic ob- structive pulmonary disease （COPD） of acute exacerbation stage. Methods 152 admitted patients with COPD of acute exacerbation stage were divided into three groups： group I with forced expiratory volume in the first second （FEV1） no less than 50% of predictive value, group II with FEV1 between 30% to 50% of predictive values, and group Ⅲ with FEVI no more than 30% of predictive value. Meanwhile according to the result of sputum culture, infective bacteria were divided into four kinds： Gram-positive cocci for kind A , Gram-negtive germ except for kind C for kind B, Acinetobacer, Enterobacter and Pseudomonas spp. for kind C, and negative result for kind D. Characteristics of bacteriology and drug resistance in varied pulmonary function participants were analyzed. Results There were 70 patients out of 152 cases with positive result of bacterium quantitative culture in sputum, and the positive rate was 46.1%. Among cultured 70 strains of positive bacteria, gram positive bacteria： numbers of streptococcus pneumonia, staphylococcus aureus, staphyiococcus epidermidis and were in turn 22 strains （26.2 %）, 6strains （7. 1%） and 4 strains（4.8 %）; Gram-negative bacteria： num- bers of pseudomonas aeruginosa, Enterobacter and klebsiella pneumoniae were 11 strains （11.9%）, 6 strains （7.1%） and 6 strains （7.1%） respectively. Part of pathogenic bacteria demonstrated a multi-drug resistance. Outcome of sputum culture in group I was mostly negative, while predominant bacteria in group Ⅲ were resistant kind A and kind C bactria, distributions in three groups displayed significant differences （P〈0.05）. Conclusion Bacterial species contracted by COPD patients of acute exacerbation stage have a certain relationship with their pulmonary function. The more chance of bacteria infection such as resisted streptococcus pneumonia, Enterobacter and Pseudomonas spp, the more damage of lung function.