贵州省黔东南州地区重症COPD患者的病原学特点及耐药性分析

Etiology and drug resistance analysis of severe chronic obstructive pulmonary disease in south east of Guizhou province

目的探讨近3年贵州省黔东南州重症慢性阻塞性肺疾病(COPD)的病原学特点及耐药情况,为临床用药提供可行性依据。方法收集2012年1月至2014年12月期间黔东南州人民医院收治的680例慢性阻塞性肺疾病(COPD)急性加重期患者的资料,分析其痰培养及药敏结果,统计所分离出菌株的分布及耐药特点。结果共分离培养出致病菌293株(培养阳性率43%),以革兰阴性菌占多数,为64.5%,位于前三位的是大肠埃希菌52株(17.7%);铜绿假单胞菌35株(11.9%);肺炎克雷伯菌28株(9.6%)。培养出的革兰阳性菌(23%),分别是金黄色葡萄球菌29株(9.9%);溶血性葡萄球菌21株(7.2%);表皮葡萄球菌9株(3.0%)。培养出真菌36株,占12%,以白色念珠菌为主。药敏结果:革兰阴性菌对美罗培南、亚胺培南敏感性好,其次是哌拉西林/他唑巴坦钠、头孢哌酮/舒巴坦,对三代头孢有不同程度的耐药。革兰阳性菌耐药率高,但未发现对万古霉素耐药,真菌对两性霉素、酮康唑、氟康唑和伊曲康唑均敏感。结论重症COPD患者感染的病原体以革兰阴性菌占优势同,且存在较为严重的耐药现象。

Objective To analyze nearly three years of etiology characteristics and drug resistance situation of severe chronic obstructive pulmonary disease（ COPD） in south east of Guizhou province,provide a reference for the region of clinical medicine. Methods It was collected 680 patients with acute aggravating period of COPD data from January 2012 to December 2014 for nearly three years in Qiandong Nanzhou People＇s Hospital,studied the sputum culture and drug susceptibility test results,the distribution and drug resistance of isolated strains by statistical characteristics. Results A total of 293 strains pathogenic bacteria culture were isolated and cultured（ culture positive rate 43%）,with Gram-negative bacteria 64. 5%,in the top three was52 strains of E. coli,accounted for 17. 7%; Pseudomonas aeruginosa 35 strains,accounting for 11. 9%;Klebsiella pneumoniae 28 strains,accounting for 9. 6%. Gram-positive bacteria（ 23%）,respectively was 29 strains of Staphylococcus aureus（ 9. 9%）; Hemolytic staphylococci 21 strains, accounting for 7. 2%;Epidermis staphylococcus 9 strains,accounting for 3. 0%. Fungus 36 strains,accounting for 12%,mainly candida albicans. Drug susceptibility results： gram negative bacteria sensitivity to beauty e. faecalis,imine pei south,followed by piperacillin sodium / he thiazole ba tan,head of cellular pp ketone / shu ba,the three generations of cephalosporins have different degree of drug resistance. Gram positive bacteria was found to vancomycin resistance,fungus of amphotericin,ketone health zun,sensitive to fluconazole and itraconazole.Conclusions Severe chronic obstructive pulmonary disease patients with acute aggravating period of pathogens in Gram-negative bacteria predominate,and there are serious drug resistance phenomenon.