老年慢性阻塞性肺疾病患者肺部感染的病原菌分布  

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

作　　者：瞿美君 曹奇峰[1] 王丹萍[1] 

机构地区：[1]台州市中西医结合医院泽国院区呼吸内科,浙江温岭317523

出　　处：《中华医院感染学杂志》2014年第17期4200-4202,共3页Chinese Journal of Nosocomiology

基　　金：温岭市科技局科技基金资助项目(WL2012-1-081)

摘　　要：目的分析老年慢性阻塞性肺疾病(COPD)合并肺部感染的病原菌分布及药敏结果,为临床合理应用抗菌药物提供参考。方法选取医院收治的91例老年COPD合并肺部感染患者,收集其痰液标本进行细菌学分析及药敏试验;根据美国临床实验室标准化研究所推荐的K-B法进行药敏试验。结果痰培养结果阳性患者73例,阳性率80.22%;培养出病原菌82株,其中52株为革兰阴性菌占63.41%,27株为革兰阳性菌占32.93%,3株为真菌占3.66%,革兰阴性菌以铜绿假单胞菌最常见,革兰阳性菌以肺炎链球菌最常见;铜绿假单胞菌和肺炎克雷伯菌对亚胺培南的敏感率较高,均>80.00%,副流感嗜血菌和流感嗜血菌均对亚胺培南耐药,阴沟肠杆菌对头孢曲松有较高的耐药率,而对亚胺培南的敏感率达100.00%;肺炎链球菌对左氧氟沙星、头孢曲松及阿莫西林/克拉维酸的敏感率均>80.00%,表皮葡萄球菌对左氧氟沙星、头孢曲松及阿莫西林/克拉维酸的敏感率均达100.00%。结论老年COPD合并肺部感染的病原菌以革兰阴性菌为主,治疗上应当根据药敏结果制定抗菌策略,不能过分依赖亚胺培南等广谱抗菌药物。OBJECTIVE To observe the distribution of pathogens causing pulmonary infections in the elderly patients with chronic obstructive pulmonary disease （COPD） and analyze the results of drug susceptibility testing so as to provide guidance for reasonable clinical use of antibiotics. METHODS Totally 91 elderly patients with COPD complicated with pulmonary infections were recruited in the study, then the sputum specimens were collected from the patients for bacteriological analysis and drug susceptibility testing, the drug susceptibility testing was performed with the use of K-B method recommended by the Clinical Laboratory Standard Institute. RESULTS The sputum specimens were cultured positive in 73 cases with the positive rate of 80.22%. A total of 82 strains of pathogens have been cultured, including 52 （63.41%） strains of gram-negative bacteria, 27 （32.93%） strains of gram-positive bacteria, and 3 （3.66 %） strains of fungi; the Pseudornonas aeruginosa was the most common species of gram-negative bacteria, and the Streptococcus pneumoniae was the predominant species of gram-positive bacteria. The drug susceptibility rates of the P. aeruginosa and Klebsiella pneumoniae to imipenem were more than 80.00% ; both the Parainfluenza haemophilus and Haemophilus influenzae were resistant to imipenem; the drug resistance rate of Enterobacter cloacae to ceftriaxone was high, however, the drug susceptibility rate to imipenem was 100.00% ; the drug susceptibility rates of the S. pneumoniae to levofloxacin, ceftriaxone, and amoxicillin-clavulanic acid were more than 80.00%; the drug susceptibility rates of the Staphylococcus epidermidis to levofloxacin, ceftriaxone, and amoxicillin-clavulanic acid were 100.0%. CONCLUSION The gram-negative bacteria are dominant among the pathogens causing pulmonary infections in the elderly patients with COPD. It is necessary to formulate the antibacterial strategies based on the results of drug susceptibility testing so as to avoid the overuse of broad spectrum antibiotics such as

关 键 词：慢性阻塞性肺疾病 肺部感染 病原菌 药敏分析 

分 类 号：R378[医药卫生—病原生物学]