慢性阻塞性肺疾病并肺部感染病原菌分析

Characteristics of bacteriology inpatients with chronic obstructive pulmonary disease combined with pneumonia

目的分析慢性阻塞性肺疾病(COPD)合并肺部感染患者的细菌学特点及药物敏感性。方法按常规方法收取278例COPD合并肺部感染患者的痰液,观察细菌培养及药敏结果。结果 COPD合并肺部感染主要为铜绿假单胞菌(22.13%)、肠杆菌属(14.50%)、流感嗜血杆菌(13.74%)、肺炎克雷伯杆菌(12.21%)等革兰氏阴性杆菌,其次为链球菌、金葡菌及表皮葡萄球菌等革兰氏阳性球菌(26.71%),真菌占11.45%。亚胺培南、衣替米星、头孢吡肟等都有较好的敏感性,革兰氏阳性球菌对万古霉素未显示耐药。铜绿假单胞菌对亚胺培南耐药性有增高趋势(耐药率31.03%),哌拉西林/他唑巴坦抗铜绿假单胞菌活性与头孢他啶相近。结论 COPD并肺部感染常见病原菌为铜绿假单胞菌、肠杆菌属、流感嗜血杆菌等,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、左氧氟沙星、亚胺培南、头孢吡肟等有较高敏感性。亚胺培南对铜绿假单胞菌耐药增加,而哌拉西林/他唑巴坦显示一定的优越性。G+球菌对万古霉素敏感,真菌感染应予重视。

【Objective】To investigate the characteristics of bacteriology and drug resistance in the patients with chronic obstructive pulmonary disease combined with pneumonia. 【Methods】The sputum of 278 patients with COPD combined with pneumonia was collected with a regular method, the bacteria were cultured, and then the drug sensitivity was analyzed with K-B method.【Results】The main bacteria in patients with COPD with pneumonia was G- bacillus, including Pseudomonas（22.13%）, Enter bacilli（14.50%）, Haemophilus influenza（13.74%）, Klebsiella（12.21%）, and secondly, G＋ bacteria（26.71%）, such as Streptococcus, Staphyloccus aureus and Staphyloccus epidermindis, and additionally, Fungus（11.45%）. Imipenem, Amikacin and Cefepime were generally sensitive to bacteria,and there was no resistance of Vancomycin to G＋ bacteria. There was an increasing resistance of Imipenem to Pseudomonas with a resistance rate 31.03%. The anti-Pseudomonas action of Piperacillin-tazobactum was equal to that of Ceftazidime.【Conclusions】The main bacteria in patients with COPD with pneumonia was G-bacillus, including Pseudomonas, Enter bacilli, Haemophilus influenza, Klebsiella, which are still sensitive to Imipenem, Amikacin, Cefepime, Cefoperazone-sulbactam, levofloxacin. To Pseudomonas, the resistance of Imipenem is increasing and Piperacillin-tazobactum works well. G＋ bacteria including MRSA is still sensitive to Vancomycin. We should pay more attention to Fungus infection.