重度慢性阻塞性肺疾病患者下呼吸道多药耐药菌感染的临床特点及病原学分析  

Clinical characteristics of multidrug-resistant bacteria causing lower respiratory tract infections in patients with severe chronic obstructive disease and etiological analysis

作　　者：裴琦[1] 刘霄[2] 刘敬禹[1] 张莉[1] 

机构地区：[1]辽宁医学院附属第三医院呼吸内科,辽宁锦州121000 [2]辽宁医学院附属第三医院神经内科,辽宁锦州121000

出　　处：《中华医院感染学杂志》2014年第5期1152-1154,共3页Chinese Journal of Nosocomiology

基　　金：锦州市卫生局联合研究基金项目(LB-20091037)

摘　　要：目的分析重度慢性阻塞性肺疾病（COPD）患者下呼吸道多药耐药菌感染的临床特点及病原学，以期提高临床诊治水平。方法收集医院2010年1月-2013年1月118例重度COPD合并下呼吸道多药耐药菌感染患者资料进行回顾性分析，所有患者均取痰标本进行细菌培养分离，观察感染患者的临床特点及主要感染病原菌。结果重度COPD下呼吸道感染后主要表现为咳嗽、痰量增加、喘息，查体显示，肺部出现干湿哕音或干湿哕音增多；共培养出135株病原菌，主要病原菌以革兰阴性菌为主76株占56．30％，其次是革兰阳性菌和真菌，分别占23．70％、20．00％；革兰阴性菌以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌为主，革兰阳性菌以金黄色葡萄球菌为主，真菌以白色假丝酵母菌为主；革兰阴性菌对头孢类、庆大霉素、哌拉西林等抗菌药物广泛耐药，耐药率为47．62％～100．00％，而对头孢哌酮／舒巴坦的耐药性为14．29％～52．94％，亚胺培南的耐药性为0～50．00％，金黄色葡萄球菌对万古霉素无耐药、对氨曲南的耐药性为17．65％，而对其他抗菌药物普遍耐药。结论COPD患者由于肺功能下降，是下呼吸道的易感人群，了解医院下呼吸道多药耐药菌感染的临床特点及主要病原菌，有利于合理选择有效的抗菌药物及治疗方案。OBJECTIVE To analyze the clinical characteristics of multidrgu-resistant bacteria causing lower respiratory tract infections in the patients with severe chronic obstructive pulmonary disease （COPD） and perform the etiological analysis so as to improve the level of clinical diagnosis and treatment. METHODS From Jan 2010 to Jan 2013, a total of 118 severe COPD patients complicated with lower respiratory tract infections caused by multidrugresistant bacteria were enrolled in the study, then the clinical data of the subjects were retrospectively analyzed, the sputum specimens were sampled from all the subjects for bacterial culture and isolation, and the clinical characteristics and the distribution of major species of pathogens were observed. RESULTS The cough, increased volume of sputum, breathing, physical examination findings, and wet, dry, or increased pulmonary rales were the major clinical manifestations of the severe COPD patients complicated with lower respiratory tract infections. A total of 135 strains of pathogens have been isolated, including 76（56.30%） strains of gram-negative bacteria, the gram-positive bacteria （23. 70 %） and fungi （20. 00 %）; the Pseudomonas aeruginosa, Klebsiella pneumoniae , and Acinetobacter baumannii were dominant among the gram-negative bacteria; the Staphylococcus aureus was the predominant species of gram-positive bacteria; the Candida albicans was dominant among the fungi. The drug resistance rates of the gram-negative bacteria to cephalosporin antibiotics, gentamicin, and piperacillin varied between 47. 62% and 100.00%, cefoperazone-sulbactam varying from 14.29% to 52.94%, imipenem ranging from 0 and 50. 00 % ; the vancomycin-resistant S. aureus strains have not been detected, the drug resistance rate to aztreonam was 17. 65 %, and the strains were generally resistant to other antibiotics. CONCLUSION The COPD patients with decreased lung function are the population at high risk of lower respiratory tract infections; the understanding of the clinical character

关 键 词：重度慢性阻塞性肺疾病 下呼吸道感染 多药耐药菌 

分 类 号：R563.1[医药卫生—呼吸系统]