慢性阻塞性肺疾病急性加重下呼吸道病原菌及耐药性分析  

Distribution and Antibiotic Resistance of Pathogens in Lower Respiratory Tract of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：邓建平[1] 陈云鹏[1] 

机构地区：[1]黄石市爱康医院检验科,湖北黄石435000

出　　处：《中华医院感染学杂志》2010年第13期1965-1967,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解慢性阻塞性肺疾病(COPD)急性加重(AECOPD)患者下呼吸道感染细菌的分类及药敏分析,为临床合理用药和控制细菌耐药性的发展提供参考。方法对2006年4月-2009年4月医院收治的418例AECOPD患者做痰细菌培养,药敏采用纸片扩散法(K-B法)。结果 418例AECOPD患者痰标本共检出致病菌309株,其中革兰阴性杆菌210株(68.0%)、革兰阳性球菌62株(20.0%)、真菌37株(12.0%);前5位病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌、肺炎链球菌和嗜麦芽寡养单胞菌;药敏发现,亚胺培南、头孢他啶、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦对大部分革兰阴性杆菌有较好敏感性,大肠埃希菌和肺炎克雷伯菌对亚胺培南的敏感率为100.0%,万古霉素、头孢他啶、氯霉素、左氧氟沙星对大部分革兰阳性球菌有较好敏感性。结论 AECOPD下呼吸道致病菌以革兰阴性杆菌为主,且耐药率较高,经验用药宜选头孢三、四代或含β-内酰胺酶抑制剂的抗菌药物。OBJECTIVE To investigate the distribution characteristics and antimicrobial resistance of bacterial isolates from patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.and provide basis for rational selection of clinical drugs.METHODS The sputum samples of 418 AECOPD patients from Apr 2006 to Apr 2009 were collected from our hospital and the drug susceptibility was determined by K-B test.RESULTS From 418 sputum specimens 309 pathogens were detected,including 210 strains（68.0%） of Gram-negative bacilli,62 strains（20.1%） of Gram-positive cocci,and 37 strains（12.0%） of fungi.The most common pathogens were Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,Acinetobacter baumannii,Streptococcus pneumoniae and Stenotrophomonas maltophilia.The results of drug sensitivity test showed that most of the Gram-negative bacilli were more sensitive to imipenem,ceftazidime,cefoperazone/sulbactam and piperacillin/tazobactam.The sensitive rate of E.coli and K.pneumoniae to imipenem was 100%.The most of the Gram-positive cocci were more sensitive to vancomycin,ceftazidime,chloramphenicol and levofloxacin.CONCLUSION Gram-negative bacilli are predominant in lower respiratory tract in AECOPD patients with higher frequency of drug resistance.The 3rd or 4th generation of cephalosporins and some antibiotics with the capability of inhibiting ESBLs are recommended in clinical application.

关 键 词：慢性阻塞性肺疾病 细菌 耐药性 抗菌药物 合理使用 

分 类 号：R378[医药卫生—病原生物学]