COPD和AECOPD住院患者病原菌分离情况和耐药分析

Distribution and drug resistant of pathogens in hospitalized patients of COPD and AECOPD

目的观察慢性阻塞性肺病(COPD)和慢性阻塞性肺疾病急性加重(AECOPD)病原菌的分布情况及耐药特点,为临床合理用药提供依据。方法回顾分析华西医院2010年1—12月1860例检出病原菌的COPD和AECOPD患者的病原菌分布,标本来源,科别及耐药性。结果 COPD和AECOPD患者病原菌主要从痰标本检出(87%,95%)。COPD患者多为老年科患者(38%),而AECOPD多为呼吸科(39%)。以革兰阴性杆菌为主(79.5%,88.3%),前3位是:不动杆菌属(21.4%,34.7%)、假单胞菌属(19.1%,20.6%)和克雷伯菌属(14.6%,10.9%)。AECOPD患者鲍曼不动杆菌的耐药性显著高于COPD患者,铜绿假单胞菌耐药率相似,但肺炎克雷伯菌对哌拉西林的耐药性COPD组显著高于AECOPD组。结论 COPD患者和AECOPD患者病原菌分布相似但耐药性有所差异,临床应根据药敏结果选用抗生素。

Objective To observe the distribution and drug resistant of pathogens in hospitalized patients of chronic obstructive pulmonary disease （COPD） and acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, so as to offer guidance reasonable clinical use of antibiotics. Methods Analysing pathogen distribution, specimen types, departments and drug resistance of 1860 COPD and AECOPD patients in West China Hospital from Jan 2010 to Dec 2014 by retrospective analysis. Results Sputum was the most common specimen （87%, 95%）. The COPD patients were mainly in the department of geriatrics （38%）, while AECOPD patients were mainly in the department of respiration （39%）. The main pathogens isolated from COPD and AECOPD patients were gram negative bacilli （88.3%, 79.5%, P〈0.05）, the topthree included： Acinetobacter （21.4%, 34.7%）, Pseudomonas aeruginosa （19.1%, 20.6%） and Klebsiella pneumoniae （14.6%, 10.9%）. The drug resistance rate of Acinetobacter baumanii of AECOPD patients was significantly higher than those of patients with COPD. The rate of Pseudomonas aeruginosa was similar, and the drug resistance rate of Klebsiella pneumonia was significantly higher in AECOPD patients than in COPD patients. Conclusion The pathogens isolated from COPD patients and AECOPD patients were similar in distribution but vary in drug resistance, so the clinical use of antibiotics should be based on the results of drug sensitivity.