老年CPFE患者急性加重期下呼吸道病原体分布及耐药情况分析

Analysis of the pathogens distribution and drug resistance in lower respiratory tract of elderly CPFE acute exacerbation patients

目的分析老年肺纤维化合并肺气肿(CPFE)患者急性加重时下呼吸道病原体分布及其耐药情况。方法选取2016年1月至2018年1月郑州颐和医院治疗的CPFE患者79例,对其痰标本进行常规病原菌培养,并进行药敏试验。结果 79例患者共送检合格痰标本72份,共有66份标本培养出致病菌,检出率为91.67%(66/72),共分离出菌株85株,其中革兰阴性菌最多(72.94%);革兰阴性菌中,以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌最多;革兰阳性菌中以金黄色葡萄球菌为主;真菌中以白假丝酵母菌为主;铜绿假单胞菌对头孢唑林和头孢呋辛耐药率较高,分别为92.31%和88.46%;肺炎克雷伯菌对哌啦西林和头孢呋辛耐药率较高,均为71.43%;鲍曼不动杆菌对头孢唑林、头孢呋辛、头孢他啶和环丙沙星耐药比较高,分别为88.89%、83.33%、83.33%、83.33%;金黄色葡萄球菌对青霉素和氨苄西林耐药比较高,分别为100.00%和100.00%。结论老年CPFE患者急性加重时,革兰阴性杆菌仍为主要感染病原体,且耐药严重,建议定期进行病原菌耐药监测,予以合理的抗感染等治疗。

Objective To analyze the pathogens distribution and drug resistance in lower respiratory tract of elderly pulmonary fibrosis combined with pulmonary emphysema (CPFE) acute exacerbation patients. Methods A total of 79 cases of CPFE patients treated in Zhengzhou Yihe Hospital from January 2016 to January 2018 were selected, its sputum samples were routine pathogens cultured, and drug sensitivity tests were carried out. Results Seventy-nine patients with 72 qualified sputum samples, 66 specimens cultured bacteria, the detection rate was 91.67%(66/72), 85 strains were isolated, of which Gram-negative bacteria were the most(72.94%);in Gram- negative bacteria, Pseudomonas aeruginosa, Acinetobacter Bauman and Klebsiella pneumoniae were the most;in Gram-positive bacteria, Staphylococcus aureus was the main;in Fungus, Candida albicans was the main;Pseudomonas aeruginosa to cefazolin and cefuroxime with high resistance ratios, were 92.31% and 88.46%;Klebsiella pneumoniae to amoxicillin and cefuroxime piperacillin with high resistance rate, all were 71.43%;Acinetobacter baumannii to cefazolin, cefuroxime, ceftazidime and ciprofloxacin with high resistance ratios, were 88.89%, 83.33%, 83.33%, 83.33%;Staphylococcus aureus resistant to penicillin and ampicillin with high resistance ratios were 100.00% and 100.00%. Conclusions CPFE elderly patients with acute exacerbation, Gram-negative bacilli are still the main pathogens, and drug resistance is serious, it is suggested that drug resistance be monitored regularly and rational anti infection treatment should be given.