慢性阻塞性肺疾病急性发作期患者下呼吸道感染的病原菌分布特点分析  

Analysis of pathogen distribution in lower respiratory tract of patients with acute episode of chronic obstructive pulmonary disease

作　　者：甘兵 吴本权[2] 潘明安[2] 黄静[2] 朱家馨[2] 张天托[2] 

机构地区：[1]广东省佛山市顺德区龙江医院呼吸科,528318 [2]中山大学附属第三医院呼吸内科,广州市510630

出　　处：《临床合理用药杂志》2010年第4期12-14,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的了解慢性阻塞性肺疾病急性发作期(AECOPD)患者下呼吸道感染的病原菌分布及耐药性特点,为合理使用抗感染药物提供依据。方法对326例AECOPD患者下呼吸道感染病原菌构成及药物敏感性结果进行分析,用K-B纸片扩散法测定药敏,最低抑菌浓度(MIC)测定采用琼脂二倍稀释法。结果326例患者共分离出菌株169株,阳性率为51.8%。培养结果以革兰阴性杆菌为主(128株,75.7%),其中铜绿假单胞菌46株(27.2%)、流感嗜血杆菌28株(16.6%)、肺炎克雷伯杆菌20株(11.8%)、不动杆菌18株(10.7%)、肠杆菌属16株(9.5%)为主要革兰阴性病原菌。革兰阳性球菌占第2位(29株,17.2%),依次为金黄色葡萄球菌(15株,8.9%),肺炎链球菌(9株,5.3%),肠球菌(5株,3.0%),真菌占第3位(12株,7.1%),以白色念珠菌为主。其中以铜绿假单胞菌、肺炎克雷伯杆菌、不动杆菌对常用抗生素具有较高的耐药性。万古霉素对绝大多数革兰阳性球菌有较好的敏感性。结论AECOPD患者下呼吸道感染病原菌以革兰阴性杆菌为主,而且耐药性较高,经验用药宜选3、4代头孢或含有β-内酰胺酶抑制剂的复合抗生素,同时应动态监测细菌耐药性,有助于制定合理的临床抗感染治疗方案。Objective To investigate the pathogen distribution and drug resistance in patients with lower respiratory infection of acute episode of chronic obstructive pulmonary disease （AECOPD） , to provide the basis for rational use of anti-infective drugs. Methods Pathogens composition and the results of drug susceptibility in 326 cases of lower respiratory tract infection patients with AECOPD were analyzed. The drug sensitivity was examined by Kribry-Bauer （ K-B ） paper method and minimal-inhibitory-concentration（MIC） was determined by agar double dilute method. Results 169 strains bacteria were obtained in 326 patients （51.8% ）. 128 strains Gram-negative bacteria were the most common kinds of bacteria（75.7% ） ,including pseudomonas aeruginosa 46 strains （27.2%）, hemophilies influenzae 28 strains （ 16.6% ）, klebsiella pneumoniae 20 strains （11.8% ） , acinetobacter 18 strains （10.7% ）, enterobacter spp 16 strains （9.5 % ）. Gram-positive bacteria accounted for No. 2 （29 strains, 17.2% ）, followed by staphylococcus aureus （ 15 strains, 8.9% ）, streptococcus pneumoniae （9 strains, 5.3% ） ,enterococcus（5 strains, 3.0% ）. Fungi accounted for No. 3 （ 12 strains, 7. 1% ）, mainly Candida albicans. Among them, pseudomonas aeruginosa, klebsiella pneumoniae, acinetobacter had high resistance for using antibiotics commonly. Vaneomyein for the majority of Gram-positive bacteria had better sensitivity. Conclusion Gram-negative bacillus are predominant in AECOPD patients and have higher frequency of drug resistance. The 3rd or 4th generation of cephalosporins and some antibiotics with the capability of inhibiting β-lactamase are recommended in clinical application with our experience. At the same time we should monitor drug-sensitivity to bacteria dynamic and use antibiotics reasonably.

关 键 词：慢性阻塞性肺疾病 急性发作期 呼吸道感染 细菌 药物敏感性 

分 类 号：R563.9[医药卫生—呼吸系统]