COPD患者呼吸道感染铜绿假单胞菌的耐药性及ESBLs检测

Situation of drug resistance and ESBLs-producing Pseudomonas aeruginosa in COPD patients combined respiratory tract infection

目的探讨慢性阻塞性肺疾病(COPD)病情严重程度不同级别和不同年龄段患者呼吸道感染中铜绿假单胞菌(PA)对抗菌药物的耐药情况和产超广谱β-内酰胺酶(ESBLs)情况。方法实验菌株为广东廉江市人民医院和广东医学院第二附属医院2012年1月至2014年1月间收治的COPD患者呼吸道分泌物中分离的102株非重复PA,对其进行抗菌药物敏感性和ESBLs检测,细菌鉴定、药敏检测、ESBLs检测和数据分析分别使用全自动微生物分析仪、琼脂稀释法、双纸片协同法完成,分析不同年龄和不同COPD严重程度PA的耐药性和产ESBLs特点。结果 102株PA中,多重耐药菌74株(72.5%),产ESBLs菌株56株(54.9%);除对阿米卡星的耐药率为19.6%外,PA对头孢他啶、环丙沙星、复方新诺明和阿奇霉素的耐药率均在30%以上。ESBLs阳性组对头孢他啶、环丙沙星和复方新诺明的耐药率明显高于ESBLs阴性组(P均<0.05);PA阳性以COPDⅢ级+Ⅳ级(84.3%)和≥60岁老年患者(66.7%)构成比高;在产ESBLs株、多重耐药株、同时产ESBLs和多重耐药的PA中,分别有89.3%、91.9%和87.5%为COPDⅢ级+Ⅳ级患者,分别有66.1%、66.2%和75.0%是老年人。结论 COPD患者呼吸道感染PA以Ⅲ、Ⅳ级病情和老年人最为常见,且PA对抗菌药物的耐药状况严峻。

Objective To investigate the situation of drug-resistance to antibacterial agents and extended spectrum β-lactamase（ ESBLs）-producing Pseudomonas aeruginosa（ PA） in different grade of severity and different age-group when respiratory tract infection in patients with chronic obstructive pulmonary disease（ COPD）. Methods The test strains were no repeat 102 strains of PA isolated from secretions of respiratory tracts in COPD patients admitted in Lianjiang City People＇s Hospital and the Second People＇s Hospital Affiliated to Guangdong Medical Collage,and the sensitivity to antibacterial drugs and ESBLs were detected. The bacteria identification,the detections of drug sensitivity and ESBLs were respectively performed by automated microbiology analyzer,agar dilution method and double disk synergy test. The data analysis used SPSS15. 0 software. The features of drug-resistance and ESBLs-producing of different degrees of severity in COPD were analyzed. Results Out of 102 strains of PA,74（ 72. 5%） were multi-drug resistant,56（ 54. 9%） were ESBLs-producing strains. The drug-resistance rates of PA to ceftazidime,ciprofloxacin,compound sulfamethoxazole and azithromycin were all more than 30 percent except amikacin（ 19. 6%）. The drug-resistance rates of ESBLs-positive strains to ceftazidime,ciprofloxacin and compound sulfamethoxazole were all significantly higher than those of ESBLs-negative strains（ all P〈0. 05）.The constituent ratios of PA-positive strains were high in patients with COPD grade Ⅲ plus grade Ⅳ（ 84. 3%） and ages more than 60 years old（ 66. 7%）. For the PA,89. 3% of ESBLs-producing strains,91. 9% of multi-drug resistant strains,87. 5% of ESBLs-producing and multi-drug resistant strains were seen in patients with COPD grade Ⅲ plus grade Ⅳ,and66. 1% of ESBLs-producing strains,66. 2% of multi-drug resistant strains,75. 0% of ESBLs-producing and multi-drug resistant strains were seen in the elderly. Conclusions PA is most seen in pulmonary infection for COPD grade Ⅲ and gradeⅣ and the old patients,and the drug-resistance situation of PA to antibacterial agents is serious.