黔江地区慢性阻塞性肺疾病急性加重期病原菌分布及耐药性分析

Analysis on pathogenic bacteria distribution and drug resistance for AECOPD patients in Qianjiang

目的 探讨该院慢性阻塞性肺疾病急性加重期(AECOPD)患者痰标本中检出病原菌的分布及耐药性分析,为临床早期治疗提供依据。方法 选取该院2014年至2016年AECOPD住院患者454例,分析患者痰培养标本病原菌分布及药敏情况。结果 54例AECOPD患者痰培养中分离出102株病原菌,阳性率为22.47%。病原菌主要以革兰阴性菌为主占70.6%(72/102),革兰阳性菌占16.7%(17/102),真菌占12.7%(13/102),革兰阴性菌中主要致病菌有铜绿假单胞菌30株(29.4%)、流感嗜血杆菌12株(11.8%)、肺炎克雷伯菌10株(9.8%)及大肠埃希菌9株(8.8%);革兰阳性球菌中肺炎链球菌12株(11.7%)、金黄色葡萄球菌5株(5.0%)。药敏结果显示,铜绿假单胞菌感染常用抗菌药物,哌拉西林、庆大霉素、头孢他啶、环丙沙星的耐药率<20.0%,亚胺培南及美罗培南耐药率<5.0%;流感嗜血杆菌常用抗菌药物复方新诺明、氨苄西林、左氧氟沙星,耐药率均>30.0%,对美罗培南耐药率<10.0%;肺炎克雷伯菌对头孢唑林、头孢曲松、氨苄西林/舒巴坦的耐药率均>30.0%,头孢他啶、头孢吡肟、庆大霉素、头孢替坦的耐药率<10.0%;大肠埃希菌对氨苄西林、头孢曲松、头孢唑林、环丙沙星、氨苄西林/舒巴坦的耐药率>50.0%,对头孢替坦、头孢他啶、头孢吡肟、亚胺培南、厄他培南的耐药性<15.0%。革兰阳性菌并未发现特殊耐药表型,对常用抗菌药物仍然很敏感。结论 细菌感染是诱导COPD加重的主要因素,以革兰阴性杆菌感染为主。通过分析本地区AECOPD病原菌的分布及耐药情况,能为临床AECOPD患者早期合理选用抗菌药物提供参考,防止多重耐药菌株及泛耐药菌株的产生。

Objective Investigate the distribution and drug resistance of pathogenic bacteria in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the hospital,and to provide evidence for early clinical treatment.Methods 454 inpatients with AECOPD in the hospital from 2014 to 2016 were selected,the distribution and drug sensitivity of pathogenic bacteria in sputum culture specimens were analyzed retrospectively.Results Totally,102 strains were gram-negative bacteria form 454 cases in cases of AECOPD patients,the positive rate was 22.47%.The main pathogens were gram negative bacteria(70.6%)(72/102),followed by gram positive bacteria accounted for 16.7%(17/102),fungi accounted for 12.7%(13/102),The main pathogens of gram negative bacteria is in 30 cases(29.4%)of Pseudomonas Aeruginosa,12 cases(11.8%)of Haemophilus influenzae Klebsiella pneumoniae in 10 cases(9.8%)and 9 cases(8.8)of Escherichia coli;gram positive Streptococcus pneumoniae in 12 cases(11.7%)and Staphylococcus aureus in 5 cases(5.0%).Drug susceptibility results showed that the resistance rate of commonly used antibiotics in Pseudomonas Aeruginosa infection,Ceftazidime,Piperacilling,Gentamicin and Ciprofloxacin was less than 20.0%,the resistance rate of imipenem and meropenem was less than 5.0%;drug resistance rate of Haemophilus influenza mainly in compound sulfamethoxazole,ampicillin and levofloxacin was more than 30.0%.Resistance rate in meropenem was less than 10.0%;antibiotic resistance rate of Klebsiella pneumoniae in cefazolin,ceftriaxone,ampicillin/sulbactam,was more than 30.0%,the drug resistance rate of ceftazidime,cefepime,gentamicin and cefazolin was lower than 10.0%;the resistance rate of Escherichia coli to ampicillin,ceftriaxone,cefazolin,ciprofloxacin,ampicillin/sulbactam was more than 50.0%,but ceftazidime,cefepime,imipenem and ertapenem was less than 15.0%.Gram positive bacteria did not find special resistance phenotype,still sensitive to commonly used antibiotics.Conclusion AECOPD patients were mainly caused by bacterial infection,the most bacterial is gram negative bacilli.By analyzing the distribution and drug resistance of pathogens in AECOPD patients,to provide reference for clinical AECOPD patients with early treatment,to prevent the emergence of multi drug resistant strains and pan resistant strains.