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 of the distribution and drug resistance of pathogens in acute exacerbation stage of chronic obstructive pulmonary disease

目的分析我院慢性阻塞性肺疾病急性加重期(AECOPD)患者的病原菌分布及耐药性。方法选择2010年1月至2018年6月在北京市和平里医院就诊的237例AECOPD患者作为研究对象,对患者痰标本进行病原菌分离培养并做耐药性分析。结果237例患者共有126例检出病原菌,检出率为53.16%,126例患者共检出病原菌308株,革兰阴性菌220株,占71.43%,革兰阳性菌51株,占16.56%,真菌37例,占12.01%。铜绿假单胞菌对头孢唑啉、氨苄西林、复方新诺明、氨苄西林/舒巴坦、呋喃妥因耐药率均为100%,对美罗培南和亚胺培南耐药率最低;大肠埃希菌耐药性较高的抗生素有头孢曲松(82.61%)、氨苄西林(76.09%)、复方新诺明(63.04%)、头孢他定(56.52%),对亚胺培南和美罗培南无耐药性;肺炎克雷伯菌耐药性较高的抗生素有头孢唑啉(90.24%)、氨苄西林(82.93%)、头孢曲松(73.17%)和呋喃妥因(68.29%),对阿米卡星、妥布霉素无耐药性;阴沟肠杆菌耐药性较高的抗生素有头孢唑啉(81.82%)、氨苄西林(68.18%)、头孢曲松(63.64%)和头孢他定(63.64%),对美罗培南和亚胺培南无耐药性;不动杆菌属耐药性较高的抗生素有呋喃妥因(86.67%)、头孢唑啉(73.33%)、头孢曲松(66.67%)和头孢他定(60.00%),对阿米卡星无耐药性。表皮葡萄球菌耐药性较高的抗生素有青霉素(92.86%)、红霉素(50.00%)、克林霉素(57.14%),对万古霉素无耐药性;金黄色葡萄球菌耐药性较高的抗生素有青霉素(91.67%)、克林霉素(66.67%)和红霉素(66.67%),对万古霉素无耐药性;肺炎链球菌耐药性较高的抗生素有红霉素(90.00%)、青霉素(60.00%)、氯霉素(50.00%)和头孢噻肟(50.00%),对万古霉素、氨苄西林无耐药性。结论我院AECOPD感染患者的病原菌感染以革兰阴性菌为主,耐药性严重,其中铜假绿单胞菌呈泛耐药。

Objective To analyze the distribution and drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the hospital.Methods A total of 237 patients with AECOPD in the Hepingli Hospital of Beijing City from January 2010 to June 2018 were selected as the research objects.The sputum samples of the patients were isolated and cultured,and the drug resistance was analyzed.Results Pathogens were detected in 126 of 237 patients,and the detection rate was 53.16%.A total of 308 strains of pathogens were detected in 126 patients,including 220 strains of Gram-negative bacteria(71.43%),51 strains of Gram-positive bacteria(16.56%),and 37 cases of fungi(12.01%).The resistance rates of Pseudomonas aeruginosa to cefazolin,ampicillin,cotrimoxazole,ampicillin/sulbactam,and nitrofurantoin were 100%,and the resistance rates to meropenem and imipenem were the lowest.Escherichia coli showed high antibiotic resistance to ceftriaxone(82.61%),ampicillin(76.09%),cotrimoxazole(63.04%),and ceftazidime(56.52%),but showed no resistance to imipenem and meropenem.Klebsiella pneumonia showed high resistance to cefazolin(90.24%),ampicillin(82.93%),ceftriaxone(73.17%),and nitrofurantoin(68.29%),but showed no drug resistance to amikacin and tobramycin.Enterobacter cloacae showed high resistance to cefazolin(81.82%),ampicillin(68.18%),ceftriaxone(63.64%),and ceftazidime(63.64%),but no resistance to meropenem and imipenem.Acinetobacter showed high drug resistance to furantoin(86.67%),cefazolin(73.33%),ceftriaxone(66.67%)and ceftazidime(60.00%),with no drug resistance to amikacin.Staphylococcus epidermidis showed high resistance to penicillin(92.86%),erythromycin(50.00%),and clindamycin(57.14%),and showed no resistance to vancomycin.Staphylococcus aureus showed high drug resistance to penicillin(91.67%),clindamycin(66.67%),and erythromycin(66.67%),and showed no resistance to vancomycin.Streptococcus pneumoniae showed high resistance to erythromycin(90.00%),penicillin(60.00%),chloramphenicol(50.00%),and cefotaxime(50.00%),with no drug resistance to vancomycin and ampicillin.Conclusion The main pathogens of AECOPD infection in our hospital are Gram-negative bacteria with serious drug resistance,among which Pseudomonas aeruginosa is extensively drug-resistant.