急诊科C、D类慢性阻塞性肺疾病急性发作患者细菌分布及耐药性分析  

Analysis of bacterial distribution and resistance from exacerbation of COPD patients in C and D Classification in our emergency department.

作　　者：蒋旭宏[1,2] 王原[3] 华军益[2] 吕宾[1,2] 

机构地区：[1]浙江中医药大学,杭州310006 [2]浙江中医药大学附属第一医院急诊科 [3]浙江中医药大学附属第一医院微生物实验室

出　　处：《中华急诊医学杂志》2013年第6期626-629,共4页Chinese Journal of Emergency Medicine

基　　金：浙江省医药卫生科技计划项目：（2012kyb142）

摘　　要：目的研究分析浙江中医药大学附属第一医院急诊科C、D类慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）急性加重患者细菌感染的分布情况及其耐药性。方法对急诊科C、D类COPD急性加重患者痰液进行培养＋药敏试验，采用VITEK-2 compact微生物分析仪鉴定细菌，采用CLSI制定的纸片扩散法进行细菌耐药分析。结果在分离出的222株细菌株中，革兰阳性（G＋）菌60株，占27．O％，革兰阴性（G＋）菌162株，占73．0％。G＋菌主要为金黄色葡萄球菌和肺炎链球菌，耐甲氧西林金黄色葡萄球菌（MRSA）检出率为50．00％，耐药率显著高于甲氧西林敏感的金黄色葡萄球菌（MSSA），对万古霉素、利奈唑胺、替加环素均敏感（100％）。G＋菌主要为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌，非发酵菌铜绿假单胞菌和鲍曼不动杆菌的耐药率较高，肠杆菌科中大肠埃希菌产超广谱β-内酰胺酶（ESBLs）菌株检出率高于肺炎克雷伯菌，具有多重耐药性。结论急诊科C、D类COPD急性加重患者的细菌耐药形势严峻，铜绿假单胞菌分离率最高，需加强耐药件检测，及时有效榨制感染减少耐药率。Objective To analyze the bacterial distribution and resistance of clinical isolates from exacerbation of COPD patients in C and D classification in our emergency department. Methods The sputums were taken to culture and antimicrobial susceptibility test. VITEK-2 compact automicrobe system was used to identify bacteria. Disc diffusion test was used to determine the antimicrobial resistance. Results Of 222 clinical isolates, 27.0% were Gram positive bacteria, 73.0% were Gram negative bacteria. The Gram positive bacteria mainly was Staphylococcus aureus and Streptococcus pneumoniae. The detection rates of methicillin-resistant Staphylococcus aureus （MRSA） were 50. 00%. The MRSA were more resistant than methicillin-sensitive Staphylococcus aureus （MSSA） , and they were all sensitive to vancomycin, linezolid or tigecycline. The Gram negative bacteria mainly was Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp and Acinetobacter baumannii. Pseudomonas aeruginosa and Acinetobacter baumannii had high resistant rates.The extended spectrum β-lactamases （ESBLs） producing strains in Escherichia coli were higher than in Klebsiella spp, which had multiple drug resistance. Conclusions The bacterial resistance situation is very severely in exacerbation of COPD patients in C and D classification in our emergency department. The first isolating rate was Pseudomonas aeruginosa. Surveillance of bacterial resistance is very important and effective control measures to reduce resistance is very necessary.

关 键 词：细菌耐药 抗菌药物 慢性阻塞性肺病 细菌分布 急诊科 急性加重 耐药性检测 减少耐药率 

分 类 号：R446.5[医药卫生—诊断学]