COPD有创机械通气患者下呼吸道病原学及耐药性分析

Analysis of Pathogenic and Drug Resistance of Lower Respiratory Tract in COPD Patients Under-went Invasive Mechanical Ventilation

【目的】探讨慢性阻塞性肺疾病（COPD）有创机械通气患者下呼吸道病原菌的构成及主要病原菌的耐药性。【方法】选取2011年1月到2014年12月在本院接受有创机械通气治疗的cOPD患者380例，采集患者下呼吸道分泌物培养，分析病原菌构成比和主要病原菌的药敏结果。【结果]380例患者下呼吸道分泌物中共检出病原菌342株，其中革兰阴性菌223株（65．20％），革兰阳性菌92株（26．90%），真菌27株（7．89％）。革兰阴性菌中常见鲍曼不动杆菌53株（23．77％）、嗜麦芽窄食单胞菌48株（21．52％）、铜绿假单胞菌42株（18．83％），肺炎克雷伯菌34株（15．25％）；革兰阳性菌中常见金黄色葡萄球菌31株（9．06％）、肺炎链球菌24株（7．02％）、溶血葡萄球菌16株（4．68％）、表皮葡萄球菌14株（4．09％）；真菌常见白色念珠菌11株（3．22％）、热带念珠菌8株（2．34％）、曲霉菌6株（1．75％）。鲍曼不动杆菌对庆大霉素、阿米卡星、妥布霉素和米诺环素较敏感；嗜麦芽窄食假单胞菌对环丙沙星和左氧氟沙星敏感。铜绿假单胞菌对环丙沙星、左氧氟沙星、妥布霉素和米诺环素敏感；肺炎克雷伯菌对亚胺培南／西司他丁阿米卡星、妥布霉素、环丙沙星和左氧氟沙星敏感；革兰阳性菌对万古霉素、替考拉宁、利福平、利奈唑胺和复方新诺明敏感；除曲霉菌外，白色念珠菌和热带念珠菌对各抗真菌药物均较敏感。【结论】COPD有创机械通气患者感染率高，耐药广泛。了解本院病原菌分布、掌握耐药情况可为临床合理使用抗菌药物，减少耐药率，提高治愈率，缩短治疗时间提供依据。

[Objective]To investigate the composition and drug resistance of pathogens in lower respiratory tract in patients with chronic obstructive pulmonary disease （COPD） with invasive mechanical ventilation. [Methods] The 380 pa- tients with COPD who were treated with invasive mechanical ventilation in our hospital from January 2011 to December 2014 were selected as the study subjects. The lower respiratory tract secretions of patients were collected and cultured, The pathogenic bacteria composition ratio and main sensitivity results of pathogenic bacteria drug were analyzed.[Results] In 380 cases of lower respiratory tract secretions, 342 strains of pathogenic bacteria were detected, including 223 gram negative bacteria （65.20%）, 92 strains of gram positive bacteria （26.90%） and 27 strains of fungi （7.89%）. Among the gram negative bacteria, 53 strains of Acinetobacter Bauman （23.77 %）, 48 strains of Stenotrophomonas maltophilia （21.52 %）, 42 strains of verdigris pseudomonas （18.83 %） and 34 strains of Klebsiella pneumonia （15.25 %）. Among the gram positive bacteria, 31 strains of Staphylococcus aureus （9.06%）, 24 strains of Streptococcus pneumonia （7.02%）, 16 strains of Staphylococcus haemolyticus （4.68%） and 14 strains of Staphylococcus epidermidis （4.09%）. 11 strains of Candida albicans （3.22 % ）, 8 strains of Tropical Candida （2.34 % ） and 6 strains of Aspergillus （1.75 % ）. Bauman Acine- tobacter was sensitive to gentamicin, Amikacin, tobramycin and minocycline. Stenotrophomonas maltophilia was sensitive to ciprofloxacin and levofloxacin. Pseudomonas aeruginosa was sensitive to ciprofloxacin, levofloxacin and tobramycin and minocycline. Klebsiella pneumoniae was sensitive to imipenem, Amikacin, tobramycin, ciprofloxacin and levofloxacin. The gram positive bacteria were sensitive to vancomycin and teicoplanin, rifampicin, linezolid and sulfamethoxazole com- pound. Except for Aspergillus, Candida albicans and Tropical Candida were more sensitive to antifungal agents. [Conclu- sion] The infection rate and drug resistance rate of COPD are high. To understand the distribution and drug resistance of pathogenic bacteria in our hospital can provide the basis for clinical rational use of antibiotics, reduce drug resistance rate and improve the cure rate and shorten the treatment time.