慢性阻塞性肺病社区获得性肺部感染病原菌分析与治疗

Analysis and Treatment of Pathogens of Community Acquired Pulmonary Infection in Chronic Obstructive Pulmonary Disease

目的分析慢性阻塞性肺疾病并发社区获得性肺部感染中常见的病原菌与治疗方法。方法选取2017年2月至2019年3月江苏省东台台东医院收治的494例慢性阻塞性肺疾病并发社区获得性肺部感染患者选做研究对象,所有入选患者开展痰培养检验诊断,以及药敏试验检验诊断,并对相关数据进行分析。结果494例慢性阻塞性肺疾病并发社区获得性肺部感染患者,有306例患者明确检出病原菌,其检出率为61.94%(306/494),其中检出铜绿假单胞菌71例(23.20%),检出肺炎克雷伯菌55例(17.97%),检出鲍氏不动杆菌40例(13.07%),检出肺炎链球菌61例(19.93%),检出金黄色葡萄球菌38例(12.41%)。结论慢性阻塞性肺疾病患者在并发社区获得性肺部感染中的主要致病微生物类型为革兰氏阴性菌(主要有铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌)居多,革兰阳性菌(肺炎链球菌、金黄色葡萄球菌)相对较少,主要病原菌对大部分常用的化学抗菌类药呈不同程度的耐药性,临床需要结合痰液菌培养检测情况,诊断感染病原菌种类,适当规避耐药性问题,选择合适的抗菌药治疗,并动态调整用药,提高治疗效果。

Objective To analyze the common pathogens and treatment of COPD complicated with community acquired pulmonary infection.Methods From February 2017 to March 2019,494 patients with chronic obstructive pulmonary disease complicated by community acquired pulmonary infection in Taidong Hospital,Dongtai Jiangsu Province were selected as the study subjects.Sputum culture experiments and drug sensitivity tests were carried out in all the selected patients,and the data were analyzed.Results A total of 494 patients with COPD complicated with community acquired pulmonary infection,306 patients were found to have pathogenic bacteria.The detection rate was 61.94%(306/494).Pseudomonas aeruginosa(23.20%)was detected in 71 patients,Klebsiella pneumoniae(17.97%)was detected in 55 patients and 40 patients.Acinetobacter baumannii(13.07%),Streptococcus pneumoniae(19.93%)and Staphylococcus aureus(12.41%)were detected in 61 patients.Conclusion Gram-negative bacteria(mainly Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii)are the main pathogenic microorganisms in patients with chronic obstructive pulmonary disease complicated with communityacquired pulmonary infection.Gram-positive bacteria(Streptococcus pneumoniae,Staphylococcus aureus)are relatively few and the main diseases are relatively rare.The bacteria are resistant to most commonly used chemical antimicrobial agents in varying degrees.Clinically,it is necessary to diagnose the types of pathogenic bacteria,avoid drug resistance properly,select appropriate antimicrobial agents,and dynamically adjust the use of drugs to improve the therapeutic effect.