老年COPD合并气胸患者下呼吸道感染病原菌特点及药敏分析

Pathogenic characteristics and drug sensitivity of lower respiratory tract infection in elderly patients with chronic obstructive pulmonary disease and pneumothorax

目的分析老年慢性阻塞性肺疾病(COPD)合并气胸患者下呼吸道感染病原菌特点及药敏情况,为临床用药提供指导和依据。方法 2011年1月至2016年10月采用病原微生物分离鉴定技术和药敏试验对该院老年COPD合并气胸患者送检的243份标本进行检测。结果 243份标本中共分离出108株病原菌,其中革兰阴性杆菌82株,占75.9%;革兰阳性球菌16株,占14.8%;真菌10株,占9.3%。检出率最高的4种病原菌为铜绿假单胞菌(19.4%)、肺炎克雷伯菌(17.6%)、鲍曼不动杆菌(14.8%)、大肠埃希菌(10.2%)。革兰阴性杆菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦敏感性较好;金黄色葡萄球菌对万古霉素、替考拉宁和呋喃妥因的敏感性为100.0%,对其他抗菌药物均呈现出较高的耐药性。结论老年COPD合并气胸患者下呼吸道感染病原菌以革兰阴性杆菌为主,需加强药物敏感性监测。

Objective To analyze the pathogenic characteristics and drug sensitivity of lower respiratory tract infection in elderly patients with chronic obstructive pulmonary disease （COPD） and pneumothorax, in order to provide guidance and evidence for clinical medication. Methods Totally 243 submitted specimens of elderly patients with COPD and pneumothorax,which were detected by pathogenic microorganism isolation and identification technique and drug susceptibility test,in Chougqing People＇s Hospital from January 2011 to October 2016 were selected. Results A total of 108 strains of pathogens were isolated from 243 specimens,including 82 strains of gram-negative bacteria accounted for 75.9%, 16 strains of gram-positive bacteria accounted for 14.8% and 10 strains of fungi accounted for 9.3%. The most predominant pathogen isolated was Pseudomonas aeruginosa with the detection rate of 19.4% ,followed by Klebsiella pneumoniae （17.6%）,Acinetobacter bamnanii （14.8%） and Escherichia coli （10.2%）. The sensitivity of gram-negative bacteria were good to imipenem, meropenem and cefoperazone/sulbactam ; the sensitivity of staphylococcus aureus to vancomycin, teicoplanin and nitrofurantion were both 100.0%, but the drug resistance to other antibiotics was relatively high. Conclusion Gram-negative bacteria are the predominant pathogens causing lower respiratory tract infections in elderly patients with COPD and pneumothorax, therefore, monitoring of drug sensitivity should be strengthened.