慢性阻塞性肺疾病急性加重期患者感染病原菌及耐药性分析

Pathogens and drug resistance of acute exacerbation of chronic obstructive pulmonary disease infection

目的分析慢性阻塞性肺疾病急性加重期患者感染病原菌种类及分布特征和耐药性。方法选取2012年1月至2015年1月在郏县人民医院接受治疗的慢性阻塞性肺疾病急性加重期患者190例。在患者入院后24 h内采痰标本,然后对标本进行培养,染色镜检,分离鉴定病原菌种类。对常见病原菌使用抗菌药物进行药敏试验,判断病原菌耐药性。结果 190例患者共分离病原菌230株。其中革兰阳性菌25株(10.87%),革兰阴性菌194株(84.35%),真菌11株(4.78%)。革兰阴性菌构成比明显高于革兰阳性菌和真菌,差异有统计学意义(P<0.05)。其中,铜绿假单胞菌48株,占20.87%,是最常见的病原菌,其次为鲍曼不动杆菌和肺炎克雷伯杆菌,各占19.13%、16.96%。铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯杆菌对氨苄西林耐药率均较高,分别为97.91%、68.18%以及97.44%;三种病原菌对左旋氧氟沙星耐药率较低,分别为25.00%、52.27%和10.26%。结论慢性阻塞性肺疾病急性加重期病原菌感染主要为革兰氏阴性菌,其中,铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯杆菌是常见病原菌,对不同病原菌进行药敏试验,观察其耐药性对于提高治疗效果至关重要。

Objective To analyze and discuss with chronic obstructive pulmonary disease in patients with acute exacerbation of infection and distribution of pathogens and drug resistance. Methods 90 cases of chronic obstructive pulmonary disease in patients with acute exacerbation were selected from January 2012 January 2015 in our hospital for treatment. Sputum samples were collected from patients admitted to hospital within 24 h and pathogens were cultured and identified. Drug resistance was determined. Results 230 pathogens were isolated from 190 cases of patients, with Grampositive bacteria 25,accounting for 10.87%,Gram-negative bacteria 194,accounting for 84.35%,and Fungi 11,accounting for 4.78%. Gram-negative bacteria constituted a significantly higher ratio than those of Gram-positive bacteria and fungi;the difference was statistically significant（P 〈0.05）. Among them, Pseudonym dinosaur 48, accounting for20.87%, was the most common pathogen, followed by Bahamanian and Kielbasi pneumatic, with 19.13 percent and16.96 percent, respectively. Pseudonym dinosaur, Bahamanian and Kielbasi pneumatic resistance to penicillin were high,respectively 97.91%, 68.18% and 97.44%. Levofloxacin resistances of three kinds of pathogens were low,25.00%,52.27% and 10.26%, respectively. Conclusions Acute exacerbation of pathogen infection wasmainly caused by Gramnegative bacteria, Pseudonym dinosaur,Bahamanian and Kielbasi pneumatic.Susceptibility testing of different pathogens observed drug resistance is essential to improve the therapeutic effect.