贵阳地区慢性阻塞性肺疾病急性加重期下呼吸道细菌感染特征和耐药性分析  

Infection Feature and Drug Resistance of Bacteria of Inferior Respiratory Tract in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Guiyang of China

作　　者：周忠[1] 王燕[1] 蔡翠[1] 龙海[1] 张娟[1] 查小芳[1] 

机构地区：[1]贵州省贵阳市肺科医院,550003

出　　处：《中国全科医学》2011年第6期648-651,共4页Chinese General Practice

基　　金：贵阳市卫生局基金资助项目(筑卫科教[2008]40号)

摘　　要：目的通过分析慢性阻塞性肺疾病急性加重(AECOPD)患者痰及纤支镜刷取的下呼吸道分泌物的细菌培养及药敏实验结果,探讨贵阳地区AECOPD患者下呼吸道细菌感染的差异,为临床治疗提供依据。方法对2009-04-01—2010-04-30住我院的贵阳地区254例AECOPD患者的合格痰及纤支镜刷取的下呼吸道分泌物进行细菌培养、分离及鉴定,培养出1株或多株细菌。结果 254例AECOPD患者中有215例细菌培养阳性,阳性率为84.65%,共培养出516株致病菌。前6种致病菌依次为卡他莫拉菌315株(59.11%)、草绿色链球菌108株(20.93%)、大肠埃希菌22株(4.26%)、产气肠杆菌14株(2.71%)、肺炎克雷伯菌14株(2.71%)及峰房哈夫尼亚菌11株(2.13%)。单一细菌感染154例(71.63%),混合细菌感染61例(28.73%)。单一细菌感染是AECOPD严重程度的主要影响因素,单一细菌感染及混合细菌感染与AECOPD严重程度均呈直线回归关系。60例AECOPD患者多次培养出相同菌株而其耐药结果不同。卡他莫拉菌等前6种细菌对青霉素、氨苄西林、红霉素、氧氟沙星及环丙沙星有较高的耐药菌株发生,大多数革兰阴性杆菌对头孢类抗菌药物有相对较低的耐药菌株发生。痰细菌培养阳性与肺心病心功能严重程度呈正相关。结论贵阳地区AECOPD下呼吸道细菌感染以卡他莫拉菌及草绿色链球菌为主,而肺炎链球菌与流感嗜血杆菌不是常见致病菌。随着AECOPD严重程度的加剧,要警惕混合细菌感染的可能。合理使用抗菌药物,特别是联合抗菌药物治疗是关键。Objective To investigate the infective bacteria of inferior respiratory tract by analyzing sputum and secretion from inferior respiratory tract in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） in Guiyang of China,and to provide evidence for clinical therapy.Methods Sputum and secretion of inferior respiratory tract of 254 patients with AECOPD admitted in our hospital from 1 April 2009 to 30 April 2010 in Guiyang were cultured and drug sensitivity tests were conducted,with one or more strains of bacteria being cultured.Results Positive sputum and secretion of inferior respiratory tract culture were found in 215（84.65%） patients with AECOPD,and 516 strains of pathogenic bacteria were cultured.Among these bacteria,the six main pathogenic bacteria were 305（59.11%） strains of moraxella catarrhalis,108（20.93%） strains of streptococus viridans,22（4.26%） strains escherichia coli,14（2.71%） strains of enteroaerogen,14（2.71%） strains of klebsie pneumoniae and 11（2.13%） strains of hafnia alvei.There were single infective bacteria in 154 patients with AECOPD and mixing infective bacteria in 61 patients with AECOPD.Single infective bacteria were the mainly influence factors for the severity of AECOPD.Single infective bacteria and mixing infective bacteria both showed linear regression correlation with the severity of AECOPD.The same bacterial isolates were founded many times in sputum cultures,but the drug resistances of these outcomes were not the same in 60 patients with AECOPD.Six main types of pathogenic bacteria had more drug resistance（moraxella catarrhalis et al） to penicillin,ampicillin,erythromycin,ofloxacin and ciprofloxacin.Most of the gram-negative bacillus had low drug resistance to cephalosporins.The positive sputum germiculture was positively correlated with the severity of heart function of corpulmonale.Conclusion The moraxella catarrhalis and treptococus viridans are the main pathogenic bacteria in inferior respiratory tract in patients wi

关 键 词：肺疾病 慢性阻塞性 呼吸道感染 细菌感染 微生物敏感性试验 贵阳 

分 类 号：R563[医药卫生—呼吸系统]