慢性阻塞性肺疾病急性加重患者病原菌及耐药性分析

Analysis of the distribution and drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease

目的了解慢性阻塞性肺疾病急性加重（AECOPD）患者下呼吸道感染病原菌分布及耐药特点。方法选取该院2013-2014年住院的262例AECOPD患者痰液或纤支镜刷取下呼吸道分泌物进行细菌培养鉴定及药敏试验,并进行分析。结果分离出病原菌的患者有215例,分离到病原菌281株,其中革兰阴性杆菌190株（67.6%）,革兰阳性球菌76株（27.1%）,真菌15株（5.3%）。居前6位病原菌为鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎链球菌。药敏结果显示鲍曼不动杆菌耐药性最强,除左旋氧氟沙星、头孢哌酮/舒巴坦耐药率小于50.0%,其他药物耐药率均大于或等于75.0%。肺炎克雷伯菌和大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢曲松、头孢替坦、环丙沙星、左旋氧氟沙星、庆大霉素和复方新诺明耐药率均大于或等于70.0%。金黄色葡萄球菌对青霉素G、苯唑西林、红霉素、克林霉素全部耐药（100%）。肺炎链球菌对红霉素、克林霉素、四环素和复方新诺明耐药率均大于或等于75.0%。结论APCOPD患者下呼吸道感染病原菌以革兰阴性杆菌为主,且耐药性严重,临床选用抗菌药物治疗时应重视细菌培养和药敏试验,合理选用抗菌药物。

Objective To observe the distribution and drug resistance of pathogens cultured from the sputum of hospitalized patients with lower respiratory infection in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods To identify the germiculture and test the drug susceptibility of the sputum or respiratory secretion isolated from the bronchial brush of262 hospitalized AECOPD patients in People′s Hospital of Jiangxi Province from Janurary 2013 to December 2014 and analyze the results.Results Among all the AECOPD patients,215 cases with positive sputum culture,281 sputum pathogens were isolated.Gram-negative bacilli were found in 190（67.6%）.Gram-positive aureus were detected in 76（27.1%）.Fungus pathogens occurred in15（5.3%）.The top six pathogenic bacteria were acinetobacter baumannii,escherichia coli,klebsiella pneumonia,pseudomonas aeruginosa,staphylococcus aureus,streptococcus pneumonia.Drug susceptibility results showed that the drug resistance of acinetobacter baumannii was the strongest.Except that the drug resistance rate of cefoperazone/sulbactam and levofloxacin were less than50.0%,the others were no less than 75.0%.The drug resistance rate of escherichia coli and klebsiella pneumoniae to ampicillin,ampicillin sulbactam,cefazolin,ceftriaxone,cefotetan,gentamycin,ofloxacin,ciprofloxacin,and compound sulfamethoxazole trimethoprim were no less than 70.0%.The drug resistance rate of staphylococcus aureus to penicillin G,oxacillin,erythromycin,clindamycin were 100%.The drug resistance rate of streptococcus pneumoniae to erythromycin,clindamycin,tetracycline,sulfamethoxazole trimethoprim were greater than 75.0%.Conclusion Gram-negative bacilli are the main pathogenic bacterium in the AECOPD patients with lower respiratory infection.The key of treatment is to pay more attention to the bacterial culture and drug sensitive test,use antibiotics reasonably according to the results of drug sensitive experiment.