不同年龄人群慢性阻塞性肺疾病急性加重期病原菌分布及耐药性研究

Distribution and drug resistance of pathogens causing infections in different age patients with AECOPD

目的分析不同年龄人群慢性阻塞性肺疾病急性加重期(AECOPD)病原菌分布及其耐药性,为指导临床合理选择抗菌药物提供依据。方法收集我院2012年1月至2015年12月AECOPD患者634例,取其痰标本进行细菌培养,对不同年龄组AECOPD患者病原菌分布及其耐药性进行比较分析。结果AECOPD患者痰培养阳性313例,检出率49.35%,≥60岁组患者病原菌检出率明显高于<60岁组(χ2=12.071,P<0.05)。各年龄组病原菌分布以革兰氏阴性菌为主,其次为革兰氏阳性菌、真菌。不同年龄组比较病原菌的构成差别有统计学意义(χ2=21.134,P<0.001)。≥60岁组患者以铜绿假单胞菌所占比重最高,占22.27%;<60岁组以金黄色葡萄球菌所占比重最高,占24.81%。耐药性分析,<60岁组患者各类病原菌耐药性均明显低于≥60岁组。≥60岁组患者对革兰氏阴性菌有多重耐药,以铜绿假单胞菌最为明显,对氨苄西林/舒巴坦、头孢噻肟、氨曲南、庆大霉素的耐药率均在70%以上。结论不同年龄AECOPD患者的病原菌以革兰氏阴性菌为主。年龄较高患者病原菌的检出率高,病原菌感染种类多,耐药性高。

Objective To observe the distribution and drug resistance in different age patients with AECOPD so as to provide guidance for reasonable clinical use of antibiotics. Methods A total of 634 patients with AECOPD from 2012 to 2015 were chosen for bacteriological culture, and the distribution and drug resistance of the pathogens were analyzed in different aged groups. Results 313 cases were found positive sputum culture and the detection rate was 49.35%. The detection rate of patients over 60 years old was higher than patients under 60 years old （ ^2 = 12. 071 , P 〈 0. 05 ） . The main pathogens were Gram-negative bacteria in different age groups, followed by gram-posi-tive, and fungi. There was a significant difference in the distribution of pathogens in different age groups - 21. 134 , P 〈0. 001） . The main pathogens were pseudomonas aeruginosa accounting for 22. 27% in patients over 60 years old and staphylococcus aureus accounting for 24. 81% under 60 years old. The drug resistance of ampicillin/ sulbactam, cefotaxime, aztreonam, gentamicin was above 70% for Pseudomonas aeruginosa. Conclusion Gram-negative bacteria are the main pathogens of AECOPD patients at different ages. In the older age groups, the detection rate and drug resistance of pathogens are higher, and it has various types.