老年慢性阻塞性肺疾病患者肺部感染病原菌耐药性研究  

Drug resistance of pathogens causing pulmonary infections in elderly patients with chronic obstructive pulmonary disease

作　　者：胡小平[1] 黄文军[2] 鲁艳[3] 刘东华[1] 张权彬 

机构地区：[1]孝感市中心医院检验科,湖北孝感432000 [2]孝感市中心医院呼吸内科,湖北孝感432000 [3]孝感市中心医院感染控制办公室,湖北孝感432000 [4]孝感市惠民医院检验科,湖北孝感432000

出　　处：《中华医院感染学杂志》2014年第5期1089-1091,共3页Chinese Journal of Nosocomiology

基　　金：湖北省科技厅自然科学基金项目(2012FFC120)

摘　　要：目的探讨中心医院收治的老年慢性阻塞性肺疾病(COPD)继发肺部感染患者病原菌种类构成及其耐药性,为医师合理使用抗菌药物提供实验室参考依据。方法呼吸道标本采集与运送、病原菌培养鉴定严格按照《全国临床检验操作规程》中的临床微生物学检验章节,采用常规方法进行操作;药物敏感性检测采用K-B法,药敏结果按照CLSI的最新规则判断;采用WHONET 5.5版本统计分析数据。结果老年COPD肺部感染病原菌以革兰阴性杆菌检出率最高,检出203株占68.8%,革兰阳性球菌次之,检出61株占20.7%,真菌检出31株占10.5%;病原菌药敏检测结果表现出多药耐药现象,检出耐甲氧西林金黄色葡萄球菌19株检出率达46.3%;检出产ESBLs大肠埃希菌和肺炎克雷伯菌29株检出率49.2%;检出耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌阳性率分别为28.8%、31.4%。结论老年COPD患者继发肺部感染病原菌多为多药耐药菌,且耐药性还在持续上升,医院应加大对《抗菌药物临床应用管理办法》的执行力,实施感染病原菌检测的强制性管理,提升临床医师的抗菌药物处方水平,致力于改变抗菌药物无序应用的不良倾向。QBJECTIVE To investigate constituent ratio of bacterial species and drug resistance of bacteria causing pulmonary infection in senile patients with chronic obstructive pulmonary diseases （COPD） and provide the reference for clinical reasonable use of antibiotics. METHODS Referring to National Guide of Clinical Laboratory Procedures. Bacteria culture and identification were carried out by the routine methods. The antibiotics susceptibility testing was performed by K-B method. The result was assessed according to the latest CLSI breakpoints, and the statistical analysis was performed by WHONET 5.5 software. RESULTS Pathogens were mainly the gram-negative bacilli （203 isolates, 68.8%）, followed by the gram-positive cocci （61 isolates, 20.7%） and fungi （31 isolates, 10.5%）. Multi-resistance occurred in bacteria in vitro. 19 of strains were methicillin-resistant Staphylococcus aureus （MRSA）, accounting for 46. 3%. 29 （49.2%） of strains of ESBL-producing E. coli and K. pneumoniae were detected. The detection rates of carbapenern-resistant Pseudomonas aeruginosa and Acinetobacterbaumannii were 28.8% and 31. 4%, respectively. CONCLUSION Pathogens causing pulmonary infection in senile patients with COPD are mostly multidrug-resistant strains and the antimicrobial resistance rate is increasing. Hospital should strengthen the implement of Management of Clinical Application of Antibiotics, practise mandatory management of pathogenic detection, raise the level of antibiotic prescription in clinical physicians, and make efforts in changing the undesirable tendencies of unordered application of antibiotics in China.

关 键 词：老年患者 慢性阻塞性肺疾病 肺部感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]