慢性阻塞性肺疾病合并下呼吸道感染患者病原菌分布与耐药性分析

Analysis of Pathogenic Bacteria Bistribution and Drug Resistance in Patients with COPD and Lower Respiratory Tract Infections

目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并下呼吸道感染患者痰标本中病原菌分布及耐药性,为临床诊疗该类疾病提供参考。方法对2014年11月至2016年10月四川大学华西医院确诊COPD合并下呼吸道感染住院患者痰标本培养分离出的1 237株病原菌及非COPD下呼吸道感染住院患者痰标本培养分离出的1 453株病原菌药敏结果进行回顾分析和总结。结果在COPD合并下呼吸道感染住院患者分离出的1 237株病原菌中,革兰阴性菌、革兰阳性菌和真菌分别占80.7%、15.4%和3.9%。革兰阴性菌中以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌和大肠埃希菌多见,所占比例分别为25.6%、20.0%、17.0%、6.2%和5.5%,革兰阳性菌中以金黄色葡萄球菌、肺炎链球菌为主,所占比例分别为7.7%和6.2%。真菌以白色念珠菌最常见。革兰阴性菌对阿米卡星、头孢吡肟、亚胺培南、头孢他啶、哌拉西林/他唑巴坦和左氧氟沙星较敏感,对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢替坦、复方新罗明和头孢曲松耐药率高;革兰阳性菌中金黄色葡萄球菌对利奈唑胺、替加环素、万古霉素、左氧氟沙星、利福平、莫西沙星、苯唑西林和喹努普汀/达福普汀敏感性高,对氯洁霉素、红霉素和青霉素G耐药率高;肺炎链球菌对阿莫西林、厄他培南、左氧氟沙星、氧氟沙星、青霉素(其他)、泰利霉素、万古霉素、氯霉素、利奈唑胺和莫西沙星敏感性高,对红霉素、青霉素(口服)和四环素耐药率高。结论 COPD合并下呼吸道感染住院患者痰标本培养分离出的病原菌以革兰阴性菌为主,病原菌分布不同于非COPD下呼吸道感染患者,且对抗菌药物耐药率较高,在治疗过程中应尽快明确病原菌,合理选择抗菌药物。

Objective To analyze the pathogenic bacteria distribution and drug resistance in patients with chronic obstructive pulmonary disease（COPD）and lower respiratory tract infections and provide references for the clinical diagnosis and treatment.Methods The sensitivity and drug resistance of pathogenic bacteria were analyzed and summarized by reviewing the analysis results of 1,237 strains of pathogenic bacteria isolated from the sputum samples of the COPD patients with lower respiratory tract infections treated in West China Hospital of Sichuan University from November of 2014 to October of 2016 and 1,453 strains of pathogenic bacteria isolated from the sputum samples of the non-COPD patients with lower respiratory tract infections at the corresponding period.Results Among the 1,237 strains of pathogenic bacteria isolated from the patients with COPD and lower respiratory tract infections,80.7% of them are gram-negative bacteria,15.4% are gram-positive bacteria and 3.9% are fungi.The common bacteria in the gram-negative bacteria were pseudomonas aeruginosa,klebsiellar pneumoniae,acinetobacter baumannii,stenotrophomonas maltophilia and escherichia coli,which accounted for 25.6%,20.0%,17.0%,6.2% and 5.5% respectively.The common bacteria in gram-positive bacteria were Staphylococcus aureus and Streptococcus pneumoniae,which accounted for 7.7% and 6.2% respectively.Candida albicans is the most common in fungi.Gram-negative bacteria showed moderate susceptibility to Amikacin,Cefepime,Imipenem,Ceftazidime,Piperacillin/Tazobactam and Levofloxacin,and they showed high frequency of drug resistance to Ampicillin,Ampicillin/Sulbactam,Cefazolin,Cefotetan,Trimethoprime/Sulfamethxazole and Ceftriaxone.The staphylococcus aureus in Gram-positive bacteria showed high susceptibility to Linezolid,Tigecycline,Vancomycin,levofloxacin,rifampicin,moxifloxacin,Oxacillin,and Quinupristin/Dalfopristin,and they showed high frequency of drug resistance to chlorine lincomycin,Erythromycin and penicillin G.Streptococcus pneumoniae showed high susceptibility to amoxicillin,Ertapenem,levofloxacin,ofloxacin,penicillin（other）,telithromycin,vancomycin,chloramphenicol,Linezolid,and moxifloxacin,and they showed high frequency of drug resistance to erythromycin,penicillin（oral）and Tetracycline.Conclusion The Gram-negative bacteria are the main pathogens in the sputum samples isolated from the patients with COPD and lower respiratory infections,and the pathogenic bacteria distribution of those patients is different from that of the non-COPD patients with lower respiratory infections.The pathogenic bacteria has high rate of drug resistance to antibiotics,so antibiotics should be selected more rationally by identifying the pathogens clearly in the process of treatment.