AECOPD患者下呼吸道感染病原菌及药敏分析

Infection and drug resistance of pathogens in lower respiratory tract of patients with acute explosion chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者下呼吸道感染时痰病原菌群的分布及药敏试验结果,为临床合理应用抗菌药物提供参考依据。方法对2012年1月至2013年6月呼吸科病房110例AECOPD住院患者痰细菌培养和药敏试验结果进行分析。结果 110例AECOPD患者痰病原菌中,革兰氏阴性杆菌占50.69%,以铜绿假单胞菌、鲍曼不动杆菌、大肠埃希氏菌为主;真菌占39.33%,以白色念珠菌和曲霉菌为主;革兰氏阳性球菌占7.87%,以金黄色葡萄球菌、肺炎链球菌为主;2种以上病原菌混合感染占33.70%。细菌体外药敏试验发现:亚胺培南、美罗培南、头孢吡肟、头孢他啶、头孢哌酮舒巴坦、哌拉西林、哌拉西林他唑巴坦、左氧氟沙星、环丙沙星、氨曲南对大部分革兰阴性杆菌有较好敏感性,本组真菌对两性霉素、氟康唑、伊曲康唑、伏立康唑均敏感。万古霉素、利奈唑胺、替考拉宁、头孢呋辛、头孢噻肟钠、氯霉素对大部分革兰阳性球菌有较好敏感性。结论 AECOPD分离的细菌以革兰氏阴性杆菌为主,真菌感染率较高,应引起高度重视,各病原菌对多种抗菌药物的耐药率有上升趋势,经验用药应选择3代、4代头孢菌素和含β内酰胺酶抑制剂的抗生素,重症患者需联合抗真菌药物。

Objective To analyze the distribution of pathogens tract and their drug resistance in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods The sputum samples of 110 AECOPD patients from our hospital and the pathogen species in all samples were tested. The drug sensitivity was determined. Results Of all the pathogens found in AECOPD patients, 50.69% were Gram-negative, 39.33% were epiphytes, 7.87 % were Gram,positive, 33.70% of the patients were co-infected by more than two pathogens. Among the Gram-negative bacilli, the main pathogens included Pseudomonas aeruginosa, Acinetobacter baumannii and Egypt hopes the fungus. Among the Gram-positive cocci, the main pathogens included Staphyloccus aureus and Streptococcus pneumoniae, The results of drug sensitivity test showed that most of the Gram-negative bacilli were more sensitive to imipenem, meropenem, cefepime, ceftazidime,cefoperazone shubatan, pipercillin, pipercillin and tazobactam, levofloxacin, ciprofloxacin and aztreonam. The epiphytes were highly sensitive to amphoteric enzyme, fluconazol, itraconazole and voriconazole, while most of the Gram-positive cocci were more sensitive to vancomycin,linezolid,leicoplanin,cefuroxime,cefotaxime sodium and chloramphenicol. Conclusion Gram-negative bacilli are predominant in lower respiratory tract in AECOPD patients The ratio of mycotic infection and mixed infection are high, to which more attention should be paid. Drug resistance should be considered adequately to be used appropriately.