老年慢性阻塞性肺病急性加重期患者呼吸道致病菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in elderly patients with AECOPD

目的探讨老年慢性阻塞性肺病急性加重期(AECOPD)患者呼吸道致病菌分布与耐药性,为临床用药提供有效依据。方法对380例AECOPD患者进行呼吸道致病菌鉴定与药敏试验,以分析其菌群分布与耐药性。结果 380例患者中痰培养阳性者150例(39.47%),单一感染120例(80.00%)(细菌感染72例、真菌感染48例),混合感染30例(真菌混合感染2例、细菌合并真菌感染21例、细菌混合感染7例)。检出病原菌178株,革兰阴性杆菌134株(75.28%),以铜绿假单胞菌(35株)与鲍曼不动杆菌(26株)最为多见;革兰阳性球菌32株(17.98%),以金黄色葡萄糖球菌(17株)最为多见;另见真菌12株(6.74%)。铜绿假单胞菌对碳青霉烯类、β-内酰胺酶抑制剂复合物敏感性较高,对氨苄西林、头孢曲松耐药性较高;鲍曼不动杆菌对头孢哌酮/舒巴坦、碳青霉烯类、米诺环素耐药率较低,对其他抗生素耐药性较高;肺炎克雷伯杆菌对阿莫西林、氨苄西林、复方新诺明药物耐药性较高,对第四代头孢类抗生素、碳青霉烯类抗生素、β-内酰胺酶抑制剂复合物敏感性较高;金黄色葡萄糖球菌及肠球菌对万古霉素、替考啦宁、利奈唑胺敏感性较高。结论老年AECOPD患者呼吸道致病菌以革兰阴性杆菌为主,对抗菌药物耐药性较高,细菌培养与耐药性检测对指导临床合理用药具有重要意义。

Objective To discuss the distribution and drug resistance of pathogenic bacteria in elderly patients with AECOPD. Methods The identification and drug sensitivity test of pathogen were performed in 380 elderly AECOPD patients to discuss the distribution and drug resistance. Results 150 cases（ 39. 47%） were positive for sputum culture in the 380 patients,120 cases（ 80%） with single infection（ 72 cases with bacterial infection,48cases with fungal infection）,and 30 cases with mixed infection（ 2 cases with fungal mixed infection,21 cases with bacterial and fungal infection,7 cases of mixed bacteria infection）. 178 strains of pathogenic bacteria were detected,including 134 strains of gram negative bacilli（ 75. 28%）. The most common was Pseudomonas aeruginosa（ 35strains） and Bauman Acinetobacter（ 26 strains）. There were 32 strains of gram positive bacteria（ 17. 98%）. Staphylococcus aureus（ 17 strains） were the most common,and the other 12 strains were fungal（ 6. 74%）. Pseudomonas aeruginosa had high sensitivity to carbapenems vinyl,beta lactamases inhibitor complex,and high resistance to ampicillin and ceftriaxone. Acinetobacter baumannii coli had low resistance to Cefoperazone / sulbactam,carbapenems vinyl and minocycline,and high resistance to other antibiotics. Klebsiella pneumoniae had high resistance to amoxicillin,ampicillin,and sulfamethoxazole drugs,and high sensitivity to the fourth generation cephalosporin antibiotics,carbapenem antibiotics,and beta lactamases inhibitor complex. Staphylococcus glucose aureus and Enterococcus had high sensitivity to vancomycin and teicoplanin. Conclusion Gram negative bacilli is the main pathogens in elderly patients with AECOPD,and the drug resistance is higher. The bacterial culture and drug resistance test has important significance in the guidance of clinical rational drug use.