频发急性加重表型慢性阻塞性肺疾病患者病原菌分布及耐药性分析

Analysis on pathogenic distribution and drug-resistance in patients with frequent-exacerbation phenotype chronic obstructive pulmonary disease

目的探讨频发急性加重表型慢性阻塞性肺疾病（COPD）患者病原菌的分布及耐药性特点，为临床医师合理用药提供参考依据。方法回顾性分析我院收治的165例频发急性加重表型COPD患者的病原菌培养、菌株分离及药敏检测资料。结果165例患者共分离出病原菌133株。其中革兰阴性菌80株（60．2％），革兰阳性菌10株（7．5％），真菌43株（32．3％）。革兰阴性菌中，铜绿假单胞菌、鲍曼不动杆菌、大肠埃希杆菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌检出较多；并有耐药率高的特点。革兰阴性菌感染患者常合并真菌感染。结论频发急性加重表型COPD患者急性加重时肺部感染的病原菌以革兰阴性菌多见，常为耐药菌和（或）多重耐药菌感染；并易发生真菌等二重感染。

Objective To investigate the pathogenic distribution and drug resistance characters of patients with frequent acute exacerbation of chronic obstructive pulmonary disease （ AECOPD ）, thus providing clinicians the evidences for rational antibiotic use. Methods The data of the cuture, isolation and antimicrobial susceptibility of the respiratory pathogens was analyzed retrospectively, isolating from 165 frequent AECOPD patients in our hospital in the past two years. Results A total of 133 strains of respiratory pathogens were isolated from the 165 patients, including 80 gram-negative bacteria（60.2% ）, 10 gram-positive bacteria （7.5%） and 43 fungi （32.3%）. In the gram-negative bacteria, Pseudomanas aeruginosa, Acinetobacter baumanii, Escherichia coli, Klebsiella pneumoniae, and Stenotrophomonas malto-philia were more commonly detected and with higher rate of antibiotic resistance. Patients infected with the gram-nagative baceria were frequently double infected with fungi. Conclusion Frequent AECOPD patients are more commonly infected by gram-negative bacteria, in which （multiple） antibiotic resistant strains consist of the majority. And the gram-negative bacteria infected patients are prone to get double infection with fungi.