慢性阻塞性肺疾病机械通气患者下呼吸道感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in patients with chronic obstructive pulmonary disease undergoing mechanical ventilation

目的观察慢性阻塞性肺疾病机械通气患者下呼吸道感染病原菌的分布特点及耐药性,为临床合理选择抗菌药物提供依据。方法选取2012年1月-2014年1月102例慢性阻塞性肺疾病机械通气患者为研究对象,对其送检标本进行病原菌分离、培养鉴定,采用K-B纸片法进行药敏试验分析。结果 102份样本中共分离出病原菌109株,其中革兰阴性菌70株占64.2%,革兰阳性菌26株占23.8%,真菌13株占12.0%;共分离出多药耐药菌36株,其中铜绿假单胞菌15株占41.7%,金黄色葡萄球菌11株占30.6%,鲍氏不动杆菌8株占22.2%;多药耐药菌对常用抗菌药物均产生了较严重的耐药性,铜绿假单胞菌对阿米卡星、美罗培南、亚胺培南较敏感,耐药率<34.0%,鲍氏不动杆菌对氨曲南、哌拉西林较敏感,耐药率<13.0%,金黄色葡萄球菌对万古霉素耐药率为0。结论慢性阻塞性肺疾病机械通气患者下呼吸道感染病原菌以革兰阴性菌为主,细菌多药耐药现象严重,应引起临床人员重视。

OBJECTIVE To observe the distribution and drug resistance of the pathogens causing lower respiratory tract infections in the patients with chronic obstructive pulmonary disease undergoing mechanical ventilation so as to provide guidance for reasonable clinical use of antibiotics .METHODS A total of 102 patients with chronic ob‐structive pulmonary disease who underwent mechanical ventilation from Jan 2012 to Jan 2014 were recruited as the study objects ,then the submitted specimens were cultured for isolation and identification of the pathogens ,and the drug susceptibility testing was performed by using K‐B method .RESULTS Totally 109 strains of pathogens have been isolated from 102 samples ,including 70 （64 .2% ） strains of gram‐negative bacteria ,26 （23 .8% ） strains of gram‐positive bacteria ,and 13 （12 .0% ） strains of fungi .There were totally 36 strains of multidrug‐resistant bac‐teria isolated ,including 15 （41 .7% ） strains of Pseudomonas aeruginosa ,11 （30 .6% ） strains of Staphylococcus aureus ,and 8 （22 .2% ） strains of Acinetobacter baumannii .The multidrug‐resistant bacteria were highly resistant to the commonly used antibiotics;the drug resistance rates of the P .aeruginosa to amikacin ,meropenem ,and imi‐penem were less than 34 .0% ;the drug resistance rates of the A .baumannii to aztreonam and piperacillin were less than 13 .0% ;the drug resistance rate of the S .aureus to vancomycin was 0 .CONCLUSION The gram‐negative bac‐teria are dominant among the pathogens causing the lower respiratory tract infections in the patients with chronic obstructive pulmonary disease undergoing mechanical ventilation and are highly multidrug‐resistant ,which the cli‐nicians should pay great attention to .