慢性阻塞性肺疾病患者急性发作期痰病原学分布特点与耐药性研究  

Study on pathogenic characteristics of phlegm and drug resistance in patients with acute exacerbations of chronic obstructive pulmonary disease

作　　者：陈自瑜[1] 郑利先[1] 陈云辉[1] 叶燕崧[1] 罗巍[1] 

机构地区：[1]广东医学院附属三水医院呼吸内科,广东佛山528100

出　　处：《中华医院感染学杂志》2015年第19期4384-4387,共4页Chinese Journal of Nosocomiology

基　　金：佛山市科研基金资助项目(20108263)

摘　　要：目的：探讨慢性阻塞性肺疾病急性发作期（AECOPD）患者痰病原菌培养结果及药物敏感性，为AECOPD下呼吸道感染的病原菌流行病学分析及抗菌药物选择提供借鉴。方法对2012年1月－2013年12月住院的813例AECOPD患者痰液病原菌培养及药敏结果进行统计分析。结果813份痰标本中培养出病原菌168株，培养阳性率为20．66％；168株病原菌中，革兰阴性菌占78．57％、革兰阳性菌占8．33％、真菌占13．10％；革兰阴性菌除头孢他啶耐药率＜32．79％外，对常用的第二、三代头孢菌素均出现明显耐药，耐药率在66．76％～100．00％，大肠埃希菌的耐药性更严重，耐药率均＞87．50％，但革兰阴性菌对碳青霉烯类抗菌药物敏感性仍高，耐药率＜24．59％；革兰阳性菌对第一、二代头孢及喹诺酮类抗菌药物敏感性仍高，耐药率＜25．00％，万古霉素耐药率为0；白色假丝酵母菌对常用抗真菌药物敏感性高，耐药率＜5．00％。结论 AECOPD患者感染的病原菌以革兰阴性菌为主，大肠埃希菌耐药严重，对病情重及反复住院患者，宜选用广谱β‐内酰胺酶抑制剂的复合抗菌药物、氨基糖苷类。OBJECTIVE To investigate the results of sputum culture and drug sensitivity in patients with acute exac‐erbation of chronic obstructive pulmonary disease （AECOPD） so as to provide guidance to the epidemiological study of bacteria and the choice of antibiotics for AECOPD and lower respiratory tract infection .METHODS The results of sputum culture and drug sensitivity of 813 patients with AECOPD in our hospital from Jan .2012 to Dec .2013 were statistically analyzed .RESULTS In 813 sputum specimens ,168 strains of pathogenic bacteria were obtained .The positive rate of sputum cultivation was 20 .66% .Among the 168 pathogenic strains ,gram‐negative bacteria accounted for 78 .57% ,gram‐positive bacteria accounted for 8 .33% ,and fungi accounted for 13 .10% , respectively .Bacterial susceptibility revealed gram‐negative bacteria were significantly resistant to the common 2nd and 3rd generation cephalosporin ,with most of the drug resistance rate between 66 .76% and 100 .00% and resist‐ant to ceftazidime .The drug resistance of Escherichia coli was more serious ,all higher than 87 .50% .However , gram‐negative bacteria were sensitive to carbapenems ,and the resistance rate was lower than 24 .59% .Gram‐posi‐tive bacteria were still sensitive to 1st and 2nd generation cephalosporin and quinolone ,with most of the resistance rate lower than 25 .00% .The drug resistance rate of gram‐positive bacteria to vancomycin was the lowest ,equal to zero .Candida albicans was sensitive to the common antifungal drugs ,with the drug resistance rate lower than 5 .00% .CONCLUSION Gram‐negative bacteria are the main pathogenic bacteria for infection in patients with AE‐COPD .The drug resistance of gram‐negative bacteria ,especially E .coli ,is significant .It is suggested that pa‐tients with severe symptoms or repeatedly hospitalized should be treated with beta‐lactam antibiotics or aminogly‐cosides .

关 键 词：慢性阻塞性肺疾病 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]