慢性阻塞性肺疾病急性加重期患者痰培养革兰阴性杆菌分布及耐药性分析

Gram-negative bacilli distribution and drug resistance evolution in patients with acute exacerbation of chronic obstructive pulmonary disease

目的研究解放军某中心医院2013年—2015年慢性阻塞性肺疾病急性期患者痰培养革兰阴性杆菌分布及其耐药情况的演变,为基层医院合理使用抗菌药物提供依据。方法选取2013年1月1日—2015年12月31日解放军某中心医院呼吸内科收治的767例慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者痰培养检出的217株革兰阴性杆菌,比较3年度菌种分布及耐药情况的演变。结果革兰阴性菌共217株,近3年分别为67、67、83株,主要为大肠埃希菌,共86株,分别为31、32、23株;铜绿假单胞菌,共65株,分别为16、21、28株;肺炎克雷伯菌,共22株,分别为8、6、8株、不动杆菌,共21株,分别为5、6、10株。铜绿假单胞菌感染有逐年上升趋势,而大肠埃希菌感染呈逐年下降趋势。近3年革兰阴性杆菌对哌拉西林、替卡西林、替卡西林/棒酸耐药较严重,但从耐药趋势看有下降趋势,对哌拉西林/他唑巴坦耐药率较低却有上升趋势,对复方新诺明、妥布霉素、庆大霉素、环丙沙星等药物均耐药严重,对头孢他啶、头孢吡肟耐药明显增加,对碳青霉烯类抗生素耐药率略有升高。结论医院近3年度AECOPD患者痰培养中革兰阴性菌分离率逐年升高,且耐药严重。这一发现对该医院AECOPD革兰阴性杆菌感染患者的抗生素应用具有一定指导意义。

Objective To investigate the gram-negative bacilli distribution and drug resistance evolution in patients with acute exacerbation of chronic obstructive pulmonary disease in a Center Hospital of Chinese PLA, and provide the basis for rational use of antibiotics in primary hospital. Methods The 217 Gram-negative bacilli cultured and selected via sputum of 767 patients with acute exacerbation of chronic obstructive pulmonary disease in the Center Hospital from January 1,2013 to December 31,2015,were analyzed and compared in the evolution of species distribution and drug resistance within recent 3 years. Results In the past three years,67,67,83 strains were respectively detected including,mainly Escherichia coli,a total of 86,respectively 31,32,23 strains ; Pseudomonas aeruginosa,a total of 65,respectively as 16,21,28 strains;Klebsiella pneumoniae,a total of 22, respectively,8,6,8 strains of Acinetobacter,a total of 21,respectively 5,6,10 strains.Pseudomonas aeruginosa infection had increased year by year,and Escherichia coli infection became declining trend. Drug resistance of Gram-negative bacilli was more serious in past three years. Conclusion Gram-negative bacteria isolated rate increases year by year,and the resistance is serious,and it is important to guide use of antibiotics for the patients with acute exacerbation of chronic obstructive pulmonary disease.