慢性阻塞性肺疾病急性加重期患者病原菌分布及耐药性分析

Investigation of etiology and drug resistance in lower respiratory tract infection patients with chronic obstructive pulmonary disease during acute exacerbation

目的了解某院慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructivepulmonary disease, AECOPD）患者下呼吸道病原菌分布及药敏情况，指导临床合理应用抗菌药物。方法对该院2007年4月至2011年12月住院的718例AECOPD患者痰培养及药敏结果进行回顾性分析。结果共分离出病原菌479株，其中革兰阴性杆菌266株（55．5％），主要为克雷伯菌属、铜绿假单胞菌、大肠埃希菌及不动杆菌属；革兰阳性球菌144株（30．1％），以葡萄球菌属和肺炎链球菌为主；真菌69株（14．4％），以白色假丝酵母菌为主。极重度COPD患者革兰阴性杆菌（64．7％vs59．8％vs49．1％）和真菌的检出率（20．6％vs18．5％vs9．0％）均高于重度和中度患者（革兰阴性杆菌χ2=7．42，P〈0．05；真菌χ2=9．95，P〈0．05）。革兰阴性杆菌耐药率较低的为亚胺培南、头孢哌酮／舒巴坦、多黏菌素、莫西沙星和阿米卡星；革兰阳性球菌耐药率较低的为万古霉素、替考拉宁、利奈唑胺、喹奴普汀／达福普汀和夫西地酸。结论AECOPD患者下呼吸道感染病原菌以革兰阴性杆菌为主，是肺功能差、病情严重的患者的优势致病菌。

Objective To investigate the characteristics of the distribution and drug resistance of bacteria in lower respiratory tract isolated from patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and guide clinical rational application of antimicrobial agents. Methods Sputum culture and antimicrobial susceptibility results of 718 patients with AECOPD who were hospitalized in a hospital between April 2007 and December 2011 were retrospectively analysed. Results A total of 479 strains were isolated from all sputum samples,55.5% of them were Gram-negative bacillus including Klebsiella,Pseudomonas aeruginosa,Escherichia colt and Acinetobacter as the main pathogens. 30.1% were Gram-positive cocci mainly including Staphylococcus and streptococcus pneumoniae. 14.4% were fungus athogens and Candida albicans was the most commom pathogens. The relevance ratio of Gram-negative bacillus （64.7% vs 59.8% vs 49.1%） and fungus （20.6% vs 18.5% vs 9.0%） in very severe patients was higher than in severe or moderate ones （gram negative bacillus： χ2= 7.42, P 〈0.05. fungal ： χ2 = 9.95, P d0, 05）. The results of drug sensitivity test were ： most of the Gram-negative bacillis were more sensitive to imipenem, cefoperazone/sulbactam, polymyxin, moxifloxacin and amikacin and most of the Gram-positive bacilli were more sensitive to vaneomycin, teicoplanin, linezolid, quinupristin/ dalfopristirl and f usidic acid. Conclusions The main pathogenics in lower respiratory tract of patients with AECOPD were Gram-negative bacillus,which were the advantage ones of the more severe eases with poor lung function.