支气管扩张急性加重期病原学分布及耐药性分析  

Bacterial distribution and drug resistance in patients with acute exacerbation of bronchiectasis

作　　者：张梅[1] 骆益民[1] 杨远[1] 王西华[1] 林勇[1] 

机构地区：[1]东南大学附属中大医院呼吸科,江苏南京210009

出　　处：《中国微生态学杂志》2013年第9期1067-1070,共4页Chinese Journal of Microecology

摘　　要：目的分析不同病程支气管扩张急性加重期患者的病原及耐药情况，为临床合理用药提供参考。方法选择2010年1月至2012年12月入住东南大学附属中大医院呼吸内科经HRCT确诊的支气管扩张的138例患者，根据入院时病史记录的病程时间，将患者分成病程〈10年（组I）33例，10～20年组（组11）52例及〉20年组（组Ⅲ）53例，分析不同组间病原学构成及耐药性。结果共104例患者送检痰培养，其中有效痰标本256份，阳性标本108份（痰菌阳性率42．2％）。共分离出病原菌121株，其中，革兰阴性菌88株，革兰阳性菌17株，真菌16株。阴性菌中以铜绿假单胞菌最多（55．7％）。三组患者的痰真菌阳性率分别为7．7％、6．1％和23．9％，组间比较差异有统计学意义（P〈0．05）。在痰培养结果为阴性杆菌中，耐药情况比较普遍，其中，铜绿假单胞菌的耐药率随着病程的延长有所增加，在〉20年组患者，对亚胺培南及美罗培南的耐药率分别达到34．4％和37．5％，与其他两组问比较差异有统计学意义（P〈0．05）。结论不同病程的支气管扩张患者，革兰阴性杆菌特别是铜绿假单孢菌仍是急性加重的主要因素，大于20年病程的患者对亚胺培南及美罗培南的耐药率增高，合并真菌感染的比例增加。Objective To analyze the bacterial distribution and drug resistance at different courses of disease in patients with a- cute exacerbation of bronchiectasis. Methods 138 patients （ mean age 58.6 years） diagnosed as acute exacerbation of bronchiectasis by HRCT from January 2010 to December 2012 were enrolled and divided into three groups according to their bronchiectasis history records： 〈 10 years （group I, n =33）, 10-20 years （group II, n =52）, and 〉20 years （group III, n =53）. Their sputum samples were collect- ed for analysis of microbiology. Results 256 sputum samples were collected from 104 patients. Of all the 256 samples, 108 were found having pathogenic bacteria （ positive rate of 42.2% ）, from which 88 Gram-negative bacteria, 17 Gram-positive bacteria, and 16 fungi were isolated. There were statistically significant differences in the positive rates of fungal culture （ P 〈 0.05 ） between each group （7.7% , 6.1% and 23.9% respectively）. The Gram-negative bacilli isolated from the sputum samples showed high resistance to most common antibiotics; the drug resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 34.4% and 37.5% respec- tively in group III, compared to the other groups （P 〈 0.05 ）. Conclusion Gram-negative bacteria, especially Pseudomonas aeruginosa is still a major pathogen in acute exacerbation of bronchiectasis ; patients with more than 20 years history of bronchiectasis have a higher resistance to imipenem and meropenem and higher incidence of fungal infection.

关 键 词：支气管扩张症 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]