慢性阻塞性肺疾病呼吸衰竭患者呼吸道感染病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens causing respiratory tract infections in patients with chronic obstructive pulmonary disease

作　　者：郭宏杰 李庆洁[2] 宋娜 赵登峰 

机构地区：[1]南阳医专第一附属医院呼吸内科,河南南阳473058 [2]南阳医学高等专科学校,河南南阳473000

出　　处：《中华医院感染学杂志》2015年第8期1719-1721,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅规划基金资助项目(HW-2012B-018)

摘　　要：目的分析慢性阻塞性肺疾病(COPD)呼吸衰竭患者呼吸道病原菌分布及其耐药性,为临床治疗提供参考依据。方法收集医院呼吸内科2011年1月-2013年8月住院的140例COPD呼吸衰竭发生呼吸道感染患者送检痰液标本进行病原菌培养,采用K-B法进行药敏试验,分析导致感染的高危因素,采用SPSS13.0软件进行统计分析。结果 140例发生呼吸道感染患者痰液标本中共检出156株病原菌,以革兰阴性菌为主,共109株占69.9%,其中鲍氏不动杆菌、铜绿假单胞菌、嗜麦芽寡养单胞菌等非发酵条件致病菌为感染主要病原菌,且耐药率较高;患者年龄>70岁、入住ICU、住院时间>2周、激素应用、气管插管、机械通气、留置胃管、深静脉置管等为导致发生多药耐药菌感染的高危因素(P<0.05)。结论 COPD呼吸衰竭患者的致病菌以革兰阴性菌为主,且呈多药耐药性;临床医师要高度重视感染危险因素,积极慎重选择抗菌药物进行治疗,控制医院感染。OBJECTIVE To observe the distribution and drug resistance of pathogens causing respiratory tract infections in the patients with chronic obstructive pulmonary disease（COPD）so as to provide guidance for clinical treatment.METHODS A total of 140 COPD patients complicated with respiratory tract infections who were hospitalized the respiratory medicine department from Jan 2011 to Aug 2013 were enrolled in the study,then the submitted sputum specimens were cultured for pathogens,the drug susceptibility testing was performed with the use of K-B method,the high risk factors for the infections were analyzed,and the statistical analysis was performed with the use of SPSS13.0software.RESULTS A total of 156 strains of pathogens have been isolated from the sputum specimens that were obtained from the 140 patients with respiratory tract infections,among which the gramnegative bacteria were dominant,accounting for 69.9%（109strains）.The non-fermenting conditional pathogenic bacteria,including the Acinetobacter baumannii,Pseudomonas aeruginosa,and Stenotrophomonas maltophilia,were the predominant pathogens causing infections,and the drug resistance rates were high.The high risk factors for the multidrug-resistant bacteria infections included the more than 70 years of age,ICU stay,length of hospital stay more than 2weeks,use of hormones,endotracheal intubation,mechanical ventilation,gastric tube indwelling,and deep venous catheter indwelling（P〈0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the respiratory failure patients with COPD and show multidrug-resistant.It is necessary for the clinicians to pay great attention to the risk factors for the infections and reasonably use antibiotics for treatment so as to control the nosocomial infections.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 呼吸道感染 病原菌 耐药性 危险因素 

分 类 号：R378[医药卫生—病原生物学]