需机械通气治疗的慢性阻塞性肺疾病急性加重期患者病原学特点及耐药性分析

The Etiology Characteristics and Drug Resistance of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Who Require Mechanical Ventilation Treatment

目的通过对2011年1月-2015年8月我院需机械通气治疗的慢性阻塞性肺疾病急性加重期（AECOPD）患者病原学特点及耐药性进行总结,为此类患者获得及时、有效的治疗提供依据。方法对研究期内需转入重症监护室行机械通气治疗的AECOPD患者痰培养及药敏结果进行回顾性分析。结果共分离出病原菌137株,其中革兰阴性杆菌90株（65.7%）,居于前5位的是铜绿假单胞菌、鲍氏不动杆菌、洋葱伯克霍尔德菌、阴沟肠杆菌、肺炎克雷伯菌;革兰阳性球菌18株（13.1%）,常见的是金黄色葡萄球菌、肺炎链球菌;真菌29株（21.2%）,以白色念珠菌及烟曲霉菌为主。药敏结果显示此类患者中革兰阴性杆菌耐药情况严重,其中以鲍氏不动杆菌尤为明显;革兰阳性球菌对大多数常见抗菌药物亦表现出较强耐药性,对利奈唑胺、万古霉素、替考拉宁保持较高敏感性。结论需机械通气治疗的AECOPD患者感染病原菌以革兰阴性杆菌及真菌为主,多重耐药情况严重,AECOPD患者的早期规范治疗应进一步引起重视。

Objective To provide evidence for timely and effective treatment,the etiology characteristics and drug resistance of the people who require mechanical ventilation treatment with AECOPD（ patients with acute exacerbation of chronic obstructive pulmonary disease） were concluded in our hospital from January 2011 to August 2015. Methods Sputum culture and antimicrobial susceptibility results of patients were retrospectively analyzed,the patients were transferred to the intensive care unit to be line of mechanical ventilation in our hospital during the study period. Results A total of 137 strains were isolated from all sputum samples,Gram-negative bacilli 90 stains（ 65. 7%）,the top five included Pseudomonas aeruginosa,Acinetobacter baumannii,Onion burkholdeia bacteria,Enterobacter cloacae,Klesiella pneumoniae; Gram-positive cocci 18 stains（ 13. 1%）,mainly including Staphylococcus aureus and Streptococcus pneumoniae; Fungus athogens 29strains（ 21. 2%）,Candida Albicans and Aspergillus fumigatus were the most common pathogens. Drug susceptibility results show that the gram-negative bacterium drug resistance in severe cases,particularly with Acinetobacter baumannii; Gram-positive cocci drug resistance is also strong for common antibiotics,was sensitive to linezolid,vancomycin,teicoplanin. Conclusion The main pathogenics of patients who require mechanical ventilation treatment with AECOPD are Gram-negative bacillus and fungus,the multiple drug resistance in severe cases,so we should pay more attention to the early standard treatment in patients with AECOPD.