慢性阻塞性肺疾病急性加重期并发下呼吸道感染患者病原菌分布特点及耐药情况分析

Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Patients with Chronic Obstructive Pulmonary Disease Complicated with Lower Respiratory Tract Infection in Acute Exacerbation Stage

目的:分析慢性阻塞性肺疾病急性加重期(AECOPD)并发下呼吸道感染患者病原菌分布特点及耐药情况。方法:回顾性分析2021年2月—2022年2月漳州市中医院收治的80例AECOPD患者的临床资料,对患者痰标本进行菌株鉴定、药敏检测。分析患者病原菌菌谱、常见病原菌耐药性。结果:80例AECOPD并发下呼吸道感染患者痰标本中共分离出病原菌104株,其中革兰阴性菌占62.50%,革兰阳性菌占26.92%,真菌占10.58%,其中19例患者痰标本中分离出≥2种病原体。革兰阴性菌主要菌株为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌;革兰阳性菌主要菌株为金黄色葡萄球菌、肺炎链球菌、溶血性葡萄球菌。头孢唑啉对革兰阴性菌耐药性较高;妥布霉素、亚胺培南对革兰阴性菌耐药性较低;青霉素G、左氧氟沙星、克林霉素对革兰阳性菌耐药性较高,对苯唑西林、利奈唑胺、万古霉素无耐药性,对四环素耐药性较低;其他病原菌对不同药物耐药性差异较大。结论:AECOPD并发下呼吸道感染患者感染病原菌以革兰阴性菌为主,不同药物与病菌间耐药性差异较大。

Objective:To analyze the distribution characteristics and drug resistance of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with lower respiratory tract infection.Methods:A retrospective analysis was conducted on the clinical data of 80 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)admitted to the hospital from February 2021 to February 2022.The sputum samples of the patients were identified for bacterial strains and tested for drug sensitivity.The composition of the patient’s pathogen spectrum and the resistance of common pathogens was analyzed.Results:A total of 104 strains of pathogenic bacteria were isolated from the sputum samples of 80 AECOPD patients with lower respiratory tract infection.Gram negative bacteria accounted for 62.50%,Gram positive bacteria accounted for 26.92%,and fungi accounted for 10.58%.Among them,≥2 pathogens were isolated from the sputum samples of 19 patients.The main strains of Gram negative bacteria were Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.The main strains of Gram positive bacteria were Staphylococcus aureus,Streptococcus pneumoniae,and Hemolytic staphylococcus.Cefazolin had high resistance to gram-negative bacteria,tobramycin and imipenem had low resistance to gram-negative bacteria.Penicillin G,levofloxacin and clindamycin had high resistance to gram-positive bacteria with no resistance to oxacillin,linezolid and vancomycin,and with low resistance to tetracycline.Other pathogens had large differences in resistance to different drugs.Conclusion:The main pathogenic bacteria in AECOPD patients with lower respiratory tract infection are Gram negative bacteria.There are significant differences in drug resistance among different drugs and bacteria.