慢性阻塞性肺疾病下呼吸道感染病原学分析及抗生素选择  

Analysis and choice of antibiotics for chronic obstructive pulmonary disease in lower respiratory tract infection

作　　者：胡俊芳 罗敏 王挺 

机构地区：[1]大冶有色职工总医院呼吸内科,湖北黄石435005

出　　处：《西部医学》2016年第1期74-76,83,共4页Medical Journal of West China

基　　金：湖北省自然科学基金项目(2012FFC120)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)下呼吸道感染的病原学特点及抗生素的选择,为临床的有效治疗提供理论依据。方法采集112例慢性阻塞性肺疾病下呼吸道感染患者的痰液进行细菌培养,采用VITEK32微生物全自动分析仪进行细菌鉴定,以Kirby-Bauer琼脂法进行药敏试验,依据NCCLS手册判定试验结果。结果 112例患者痰液分离检出143株病原菌,其中感染的病原菌包括革兰阴性杆菌81株(56.64%),革兰阳性球菌46株(32.17%),真菌16株(11.19%);革兰阳性球菌对青霉素、红霉素、苯唑西林、头孢唑林球菌具有耐药性,万古霉素、利奈唑胺及替考拉宁对革兰阳性球菌的抗菌活性强;亚胺培南、阿米卡星、头孢哌酮、头孢吡肟对革兰阴性杆菌具有较强的抗菌作用。结论COPD下呼吸道感染的病原菌以革兰阴性杆菌为主,选择合理的抗生素在一定程度上可以避免耐药细菌的产生。Objective To study the chronic obstructive pulmonary disease （COPD） characteristics with lower re- spiratory tract infection pathogens and antibiotic selection and provide theoretical basis for effective clinical therapy. Methods Patients with sputum bacterial culture of respiratory tract infection collected from 112 patients with chronic ob- structive pulmonary disease. Microbial identification of bacteria and drug sensitivity test were detected by Kirby-Bauer agar method. Results 143 strains of pathogenic bacteria of 112 patients with sputum isolates were detected in 143 strains of pathogenic bacteria including 81 strains （56.64 %） Gram negative bacilli, 46 strains （32.17 %） gram positive cocci and 16 strains （11.19%） fungi. Gram positive cocci were resistant to penicillin, erythromycin, oxacillin and cefazolin and sensitive, to vancomycin, linezolid and teicoplanin. Imipenem, cefepime, cefoperazone and Amikacin had a strong anti- bacterial activity against gram negative bacilli. Conclusion The pathogenic bacteria of COPD with lower respiratory tract infection is often Gram negative bacilli. Reasonable selection of antibiotic resistant bacteria can be avoided to a certain ex- tent.

关 键 词：慢性阻塞性肺病 病原学分析 抗生素 耐药性 

分 类 号：R563[医药卫生—呼吸系统]