支气管扩张急性加重期病原学分布及耐药性特征分析

Analysis of etiology and antibiotic susceptibility in acute exacerbation of bronchiectasis

目的分析支气管扩张急性加重期患者的病原菌分布及药物敏感性,指导临床合理使用抗菌药物。方法回顾性分析2015年1月至2017年12月中国医科大学附属盛京医院呼吸内科支气管扩张急性加重期住院患者痰微生物培养及药敏试验检测结果,用Excel软件分析筛选数据,利用SPSS22.0进行统计分析。结果469例支气管扩张急性加重期患者,551份合格痰液标本,阳性菌198株,阳性率35.93%(198/551),其中细菌171株(86.36%),阳性率前三位的细菌为铜绿假单胞菌86株(50.29%)、鲍曼不动杆菌54株(31.58%)、肺炎克雷伯杆菌10株(5.85%)。铜绿假单胞菌、鲍曼不动杆菌耐药率高,其余病原微生物均有不同程度耐药。结论支气管扩张急性加重期患者的病原菌以革兰阴性菌为主。结合铜绿假单胞菌耐药特点,不建议第三代、第四代头孢菌素单独用于铜绿假单胞菌的治疗,可选择头孢他啶联合阿米卡星或头孢吡肟联合阿米卡星,临床上选择抗菌药物时应结合患者疾病特征。

Objective To Analyze the etiology and antibiotic susceptibility in exacerbated bronchiectasis,and guide rational drug use in clinic.Methods Pathogenic microorganism culture and drug sensitivity of sputum samples of 496 cases were collected from 2015 to 2016 in Shengjing Affiliated Hospital,China Medical University. The Excel software was used to analyze the screening data and the SPSS 22.0 was used for statistical analysis to obtain the drug resistance of the bacteria to the commonly used antibiotics.Results In 469 patients,there were 551 pieces of sputum,with 198 strains positive bacterium. Positive rate was 35.93% (198/551),and bacterium was 171 strains (86.36%). Bacteria of top three positive rate was 86 strains of Pseudomonas aeruginosa (50.29%),54 strains of Acinetobacter baumannii (31.58%) and 10 strains of Klebsiella pneumoniae (5.85%). The resistance rate of Acinetobacter baumannii and Pseudomonas aeruginosa was higher,and other pathogens also showed various degrees of tolerance to antibiotic.Conclusions The pathogens in patients with acute exacerbation of bronchiectasis are Gram-negative bacteria. Considering the characters of Pseudomonas aeruginosa,it is not suggested to use cephalosporin of the third and fourth generation in treating Pseudomonas aeruginosa. Clinical selection of antibiotics should combine with the disease characteristics of patients in our hospital.