不同肺功能等级AECOPD患者的病原菌分布特点分析

Analysis of distribution of pathogens for patients with acute exacerbation chronic obstructive pulmonary disease in different pulmonary function

目的:分析不同肺功能等级慢性阻塞性肺疾病急性加重(AECOPD)患者的病原菌分布特点。方法:选取2013年8月至2015年8月我院收治的80例AECOPD患者为研究对象,分析送检的痰或支气管灌洗液培养结果及耐药率,统计所有患者肺功能分级的结果,并分析不同肺功能等级病原菌差异性。结果:80例患者中共分离出病原菌72株。主要种类为革兰阴性菌,占70.83%,包括铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌;其次为革兰阳性菌,占16.67%,主要有金黄色葡萄球菌、表皮葡萄球菌及肠球菌;真菌占12.50%,其中以白色念珠菌、热带念珠菌及曲霉菌为主。铜绿假单胞菌对替卡西林、头孢他啶及替卡西林克拉维酸等有较高的耐药率;鲍曼不动杆菌对氨苄西林舒巴坦、妥布霉素、庆大霉素及哌拉西林等有较高的耐药率;肺炎克雷伯菌与大肠埃希菌则对替卡西林克拉维酸、哌拉西林他唑巴坦、头孢噻吩及头孢呋辛等有较高的耐药率。肺功能2、3、4级者革兰阴性菌的检出率分别为50.0%、52.0%和66.7%,高于1级的33.3%。肺功能1、2、3、4级者革兰阳性菌的检出率分别为50.0%、37.5%、24.0%和9.1%,4级显著低于1、2级(χ~2=6.53、4.16,P<0.05)。肺功能1、2、3、4级者真菌的检出率分别为16.7%、12.5%、24.0%和24.2%。结论:AECOPD患者中以革兰阴性菌感染为主,耐药现象较为严重,且肺功能等级越高者越容易感染革兰阴性菌及真菌。

Objective： To analyse the distribution of pathogens for patients with acute exacerbation chronic obstructive pulmonary disease （AECOPD） in different pulmonary function. Methods： 80 AECOPD patients from Augst 2013 to Augst 2015 in our hospital were selected. Censorship sputum, bronchoalveolar lavage fluid culture results, resistance rate and lung function grading results were tested and analysed. And the difference of＂ pathogenic bacteria in different lung function level were analysed. Results： 72 pathogens were isolated from 80 patients. Gram- negative bacteria was the main type which accounting for 70.83%, including Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli-based. Gram-positive bacteria accounted for16.67% , including Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus based. Fungi accounted for 12.50% , including Candida albicans, Candida tropicalis and Aspergillus based. Pseudomonas aeruginosa had a higher resistance rate to ticarcillin, ceftazidime and ticarcillin/clavulanate. Acinetobacter baumannii had a higher resistance rate to ampicillin/sulbactam, tobramycin, gentamicin and piperacillin. Klebsiella pneumoniae and Escherichia coli had a higher resistance rate to Ticarcillin/clavulanic acid, piperacillin/tazobactam, cefuroxime and cephalothin. The detection rate of Gram-negative bacteria in patients with lung function grade 2,3,4 was 50.0%, 52.0% and 66.7% respectively. Which was higher than patients with lung function grade 1 （33.3. % ）. The detection rate of Gram- positive bacteria in patients with lung function grade 1, 2,3,4 was 50.0%, 37.5%, 24.0% and 9.1% respectively. The detection rate of grade 4 was significantly lower than grade 1 and 2 （X2 = 6.53, 4.16 ; P 〈 0.05）. The detection rate of Fungus in patients with lung function grade 1, 2,3,4 was 16.7%, 12.5%, 24.0% and 24.2% respectively. Conclusion： Most AECOPD patients are infected with gram-negative bacteria. Resistance is very serious and the higher grade of lung function are more susceptible to be infect with gram-negative bacteria and fungi.