AECOPD合并Ⅱ型呼吸衰竭患者气道分泌物常见革兰氏阴性杆菌分布及耐药性分析  

Analysis of the distribution and antibiotic resistance of gram-negative bacilli in sputum of patients with acute exacerbation of chronic obstructive pulmonary disease complicated by typeⅡrespiratory failure

作　　者：刘鸿翔[1] 马爽[1] 南勇[1] 陈飞[1] 季镇星 杨婉花[1] 

机构地区：[1]上海市松江区中心医院(上海交通大学附属第一人民医院松江分院)急诊危重病科,上海201699

出　　处：《临床急诊杂志》2015年第4期293-295,298,共4页Journal of Clinical Emergency

摘　　要：目的:探讨慢性阻塞性肺病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者的气道分泌物中常见革兰阴性杆菌分布与耐药性。方法:回顾性分析2012-01-2013-09我院重症监护室接受机械通气治疗的AECOPD合并Ⅱ型呼吸衰竭患者气道分泌物中病原菌鉴定和药敏监测的结果。结果:69例患者共分离出病原菌104株,其中革兰阴性杆菌为主要致病菌,占78%。鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为优势菌群,分别占41.9%、28.4%、12.4%。非发酵菌属细菌对常用抗菌药物的耐药较为普遍,肠杆菌属细菌也逐渐呈现耐药率增高的趋势。结论:AECOPD合并Ⅱ型呼吸衰竭患者的气道分泌物中的病原菌以革兰阴性杆菌的非发酵菌和肠杆菌科为主,在未取得药敏结果之前的初始治疗时采用针对性抗菌治疗较为合理。Objective：To analyze the distribution and antibiotic resistance of common gram-negative bacilli in sputum of patients with acute exacerbation of chronic obstructive pulmonary disease complicated by typeⅡ respiratory failure.Method：A retrospective analysis was done to investigate the sputum pathogens identification and medicine sensitivity in patients with AECOPD complicated by typeⅡ respiratory failure who receiving mechanical ventilation from January 2012 to September 2013.Result：Total 104 pathogens were isolated from 69 patients,in which Gram-negative bacilli was accounted for 78%.Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae were the dominant flora,accounted for 41.9%,28.4%,12.4% respectively.Nonfermenter was generally resistant to common used antibiotics and a gradually increasing tendency of drug-resistance for enteric bacilli was also observed.Conclusion：The non-fermentative bacteria and Enterobacteriaceae are the most common sputum gram-negative bacilli in patients with AECOPD complicated by typeⅡ respiratory failure.It is more reasonable for target antimicrobial therapy in the initial treatment before getting results of drug sensitivity.

关 键 词：慢性阻塞性肺病急性加重 Ⅱ型呼吸衰竭 革兰阴性杆菌 耐药性 

分 类 号：R563[医药卫生—呼吸系统]