慢性阻塞性肺疾病伴社区获得性肺炎60例病原菌及其耐药性分析

The clinical analysis of 60 patients with chronic obstructive pulmonary disease and community-acquired pneumonia

目的 对COPD伴社区获得性肺炎病原菌和耐药情况进行分析,为临床合理用药提供依据.方法 对60例COPD伴社区获得性肺炎患者的痰液标本进行病原菌检测和药敏性试验.结果 病原菌以肺炎链球菌为主24例（40％）,其次为肺炎克雷伯菌10例（13.3％）、流感嗜血杆菌8例（16.7％）、肺炎支原体6例（8.3％）、甲型溶血性链球菌5例（6.7％）、金黄色葡萄球菌4例（3.3％）、嗜肺军团菌2例（3.3％）、其它1例（1.67％）；药敏试验显示革兰阴性菌具有较高的耐药率.流感嗜血杆菌、肺炎链球菌、嗜肺军团菌体对青霉素具有较高的耐药率.肺炎支原体、肺炎克雷伯菌对阿奇霉素表现出一定的耐药率.金黄色葡萄球菌、甲型溶血性链球菌对头孢噻吩表现出耐药性.结论 COPD伴社区获得性肺炎患者感染病菌情况主要以革兰阴性菌抗生素耐药较为严重.在之后的临床使用抗生素选择其它类的抗生素,提高临床药物抗菌疗效.

Objective To analyze the pathogens and drug resistance of patients with chronic obstructive pulmonary disease and community-acquired pneumonia,in order to provide the evidence for rational drug use in the future.Methods The sputum specimens of 60 patients with chronic obstructive pulmonary disease and communityacquired pneumonia were detected for pathogens and drug sensitivity.Results 24 patients were infected with pathogens Streptococcus pneumoniae（40%）.8 cases were infected with Haemophilus influenza（16.7%）.10 patients were infected with Klebsiella pneumonia （13.3%）.6 patients were infected with Mycoplasma lung （8.3%）.5 patients were infected with alpha-hemolytic streptococcus （6.7%）.4 patients were infected with Staphylococcus aureus （3.3%）.Two patients were infected with Legionella pneumophila （3.3%）.Unknown pathogen was one case （1.67%）.Drug sensitive test showed that gram-negative bacteria had high resistance rate.Haemophilus influenzae,Streptococcus pneumonia and Legionella pneumophila had high resistance rate against penicillin.Mycoplasma lung and Klebsiella pneumoniae showed resistance to azithromycin.Staphylococcus aureus and hemolytic streptococcus showed resistance to Cefalotin.Conclusion The patients with chronic obstructive pulmonary disease and community-acquired pneumonia were mainly infected gram-negative bacteria,which had serious antibiotic-resistant.We should choose other drugs according to the results of drug sensitive test in the future,so as to improve the anti-bacteria effect and protect the health of patients.