慢性阻塞性肺疾病急性加重期患者下呼吸道感染的革兰阴性菌分布及耐药性分析  

Distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections ;in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：周炜[1] 王月平[1] 邵雪华[1] 齐激扬[1] 彭敏飞[2] 罗敏[1] 陈存国[1] 崔丹萍[1] 

机构地区：[1]温州医科大学附属台州医院老年医学科,浙江临海317000 [2]温州医科大学附属台州医院检验科,浙江临海317000

出　　处：《中华临床感染病杂志》2016年第1期37-44,共8页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省台州市医学会科学研究基金（TZSYXH15-48）

摘　　要：目的：探讨慢性阻塞性肺疾病急性加重（ AECOPD ）下呼吸道感染的革兰阴性菌分布及对常用抗菌药物的耐药性。方法连续收集浙江省台州医院2013年1月至2014年12月收治的742例AECOPD 合并下呼吸道感染患者的痰液样本，用Vitek 2 Compact 系统联合纸片扩散法对菌株进行鉴定和药敏试验，用改良Hodge试验和乙二胺四乙酸（ EDTA ）协同试验筛选耐碳青霉烯类药物菌株。采用WHONET5．6和SPSS 20．0软件对相关数据进行统计分析。结果共分离出革兰阴性菌593株，其中非发酵菌367株（367／593，61．89％），肠杆菌科细菌220株（220／593，37．10％），其他革兰阴性菌6株（6／593，1．01％）。非发酵菌中，分离的主要菌株分别为鲍曼不动杆菌（186株）、铜绿假单胞菌（99株）、嗜麦芽窄食单胞菌（33株）和洋葱伯克霍尔德菌（22株），对氨苄西林、氨苄西林／舒巴坦、头孢唑林、头孢曲松、头孢替坦和呋喃妥因耐药率均较高，为67．20％～100．00％。另外，耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌对其他β-内酰胺类、氟喹诺酮类、氨基糖苷类、复方磺胺甲噁唑和米诺环素等抗菌药物的耐药率显著高于非耐碳青霉烯类菌株，差异有统计学意义（ P＜0.05或＜0．01）；嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌仅对左氧氟沙星、复方磺胺甲噁唑和米诺环素等少数抗菌药物敏感。肠杆菌科细菌中，分离的主要菌株分别是肺炎克雷伯菌（89株）、大肠埃希菌（80株）和阴沟肠杆菌（25株），三种肠杆菌科细菌对氨苄西林几乎完全耐药，对哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、阿米卡星和碳青霉烯类药物耐药率低，均＜15％，且产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌和大肠埃希菌对氨苄西林／舒巴坦、大部分头孢类药物（除头孢替坦和头孢哌酮／舒巴坦）、庆大霉素、妥Objective To investigate the pathogen distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease （ AECOPD） .Methods A total of 742 sputum samples were collected from AECOPD patients with lower respiratory tract infections in Taizhou Hospital of Zhejiang Province during January 2013 and December 2014.Vitek 2 Compact system combined with disk diffusion was used for strains identification and drug susceptibility test.Modified Hodge test and ethylenediamine tetraacetic acid （EDTA） synergic test were used to screen carbapenem-resistant strains.Statistical analysis was performed using WHONET 5.6 and SPSS 20.0 software.Results A total of 593 strains of gram-negative bacteria were isolated , in which 367 strains were nonfermentative bacteria （61.89%）, 220 strains were enterobacteriaceae （37.10%）, and the rest 6 strains （ 1.01%） were other gram-negative bacteria.Acinetobacter baumannii （ 186 strains ）, Pseudomonas aeruginosa （99 strains）, Stenotrophomonas maltophilia （33 strains） and Burkholderia cepacia （22 strains ） were top 4 nonfermentative bacteria , and they all showed high resistance to ampicillin , ampicillin/sulbactam, cefazolin, ceftriaxone, cefotetan and nitrofurantoin with resistant rates of 67.20%-100.00%. Drug resistance rates to other β-lactams, fluoroquinolones, aminoglycoside, compound sulfamethoxazole and minocycline were significantly higher in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains than those in non-carbapenem-resistant strains , and the differences were statistically significant （P 〈0.05 or 〈0.01）.Stenotrophomonas maltophilia and Burkholderia cepacia strains were only sensitive to levofloxacin , compound sulfamethoxazole and minocycline . Klebsiella pneumonia （89 strains）, Escherichia coli （80 strains） and Enterobacter cloacae （25 strains） were top 3 enterobacteriaceae , which were almos

关 键 词：肺疾病 慢性阻塞性 革兰氏阴性菌 碳青霉烯类 超广谱Β-内酰胺酶 抗药性 多药 

分 类 号：R446.5[医药卫生—诊断学]