慢性阻塞性肺疾病急性加重期患者病原菌特点及耐药性分析

Analysis of Pathological Bacterial Features and Tolerance of Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease

目的分析慢性阻塞性肺病急性加重期患者的病原菌种类及其耐药性,为合理使用抗菌药物提供理论依据。方法对该院2015年1月—2016年12月期间收治的180例慢性阻塞性肺病急性加重期患者进行病原菌鉴定及药敏实验,分析其病原菌特点及耐药情况。结果 180例慢性阻塞性肺疾病急性加重期患者分离出病原菌86株,其中革兰阴性杆菌占首位(67.40%),革兰阳性球菌占第二位(17.44%),真菌占第3位(6.98%)。革兰阴性杆菌中以铜绿假单胞菌(19株)、肺炎克雷伯杆菌(14株)、鲍曼不动杆菌(12株)为主要致病菌。革兰阳性球菌中以金黄色葡萄球菌(10株)、肠球菌(5株)为主。真菌以白色念珠菌(5株)为主,主要为混合感染。铜绿假单胞菌对碳青霉烯类、β-内酰胺酶抑制剂具有较高的敏感性,但是对头孢曲松和左氧氟沙星却敏感性较低;肺炎克雷伯杆菌对碳青霉烯类和β-内酰胺酶抑制剂复合物具有较高的敏感性,但是对头孢曲松敏感性较低;而鲍曼不动杆菌对头孢哌酮/舒巴坦、碳青霉烯类具有较高的敏感性,但是对其他抗生素敏感性较低;金黄色葡萄糖球菌及肠球菌对万古霉素、替考拉宁、利奈唑胺具有较高的敏感性。结论慢性阻塞性肺疾病急性加重期患者主要病原菌为革兰阴性杆菌,对抗生素耐药率较高。

Objective To analyze the pathological bacterial classification and tolerance of patients with acute exacerbation chronic obstructive pulmonary disease thus providing theoretical basis for the rational use of antibacterials.Methods 180 cases of patients with acute exacerbation chronic obstructive pulmonary disease admitted and treated in our hospital from January 2015 to December 2016 were selected for pathological bacterial identification and drug sensitivity test,and the pathological bacterial features and tolerance were analyzed.Results 86 strains of pathological bacteria were isolated from 180 cases of patients with acute exacerbation chronic obstructive pulmonary disease,the gram negative bacilli was in the first place(67.40%),the gram positive coccus was in the second place(17.44%),and the funguses were in the third place(6.98%),and the major pathological bacteria of gram negative bacilli were pseudomonas aeruginosa(19 strains),klebsiella pneumonia(14 strains)and baumanii(12 strains),and the gram positive coccus were dominated by the staphylococcus aureus(10 strains)and enterococcus(5 strains),and the fungus was dominated by endomyces albicans(5 strains),mainly the mixed infection,and the pseudomonas aeruginosa was of higher sensitivity to carbapenems and beta lactamase inhibitors,however,the sensitivity to ceftriaxone and levofloxacin was low,and the klebsiella pneumonia was of higher sensitivity to carbapenems and beta lactamase inhibitors,but the sensitivity to carbapenems was higher,but the sensitivity to other antibiotics was lower,and the sensitivity of staphylococcus aureus and enterococcus to vancomycin,teicoplanin,linezolid was higher.Conclusion The major pathological bacteria of patients with acute exacerbation chronic obstructive pulmonary disease has higher tolerance to antibiotics,and the bacterial culture results and analysis of tolerance is of guidance significance to the clinical medication.