318例慢性阻塞性肺疾病急性加重期病原菌分布及耐药分析  

作　　者：闻文波 徐宏权[2] 

机构地区：[1]浙江省余姚市梨洲医院(余姚市康复医院),315400 [2]浙江省余姚市人民医院,315400

出　　处：《浙江临床医学》2018年第6期1106-1108,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析慢性阻塞性肺疾病急性加重期（AECOPD）患者病原菌分布情况及耐药特点，为临床合理选用抗生素提供参考。方法回顾性分析318例AECOPD患者痰标本细菌培养及药敏结果。结果318例AECOPD患者下呼吸道痰标本中249例培养出病原菌，共计281株，其中革兰氏阴性杆菌169株（60．14％），前三位为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌，其构成比分别为15．30％、13．52％和9．61％；革兰阳性球菌83株（29．54％）和真菌29株（10.32％）。革兰氏阴性杆菌对哌拉西林、氨苄西林／舒巴坦、一代及二代头孢、磺胺甲嗯唑耐药率较高，而亚胺培南、左氧氟沙星、阿米卡星、头孢哌酮／舒巴坦对其保持较高的抗菌活性。金黄色葡萄球菌和溶血葡萄球菌对青霉素耐药率均〉90％，对利奈唑胺、替加环素和万古霉素保持较高的敏感性。结论AECOPD患者病原菌以革兰阴性杆菌为主，存在普遍耐药现象，临床根据药敏试验合理使用抗生素，是治疗AECOPD的重要手段。Objective To analyze the pathogenic bacteria distribution and drug resistance features in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） of our hospital, and to provide references for reasonable use of antibiotics in clinical practice. Methods The results of bacterial culture and drug sensitive test of the sputum specimen in 318 AECOPD patients were retrospectively analyzed. Results Among the sputum specimen of the lower respiratory tract of the 318 AECOPD patients, totally 281 strains of pathogenic bacteria were cultured in 249 patients. Among them, 169 strains （60.14%） were Gram-negative bacillus, and Pseudomonas aeruginosa （15.30%）, klebsiella pneumoniae （13.52%）, and baumanii （9.61%） were the top three; 83 strains （29.54%） were Gram-positive coccus; and 29 strains （10.32%） were fungus. Gram-negative bacillus had high resistance rates to piperacillin, ampicillin / sulbactam, the first- and second- generation cephalosporin, and sulfamethoxazole, and was comparatively highly sensitive to imipenem, levofloxacin, amikacin, and cefoperazone / sulbactam. Both Staphylococcus aureus and Staphylococcus haemolyticus had resistance rates to penicillin of 90% above, and were comparatively highly sensitive to linezolid, tigecycline, and vancomycin. Conelusion In AECOPD patients, the pathogenic bacteria are predominantly Gram-negative bacillus, and are generally resistant. Thus, in clinical practice, reasonably using antibiotics according to the drug sensitive test results is an important method to treat AECOPD.

关 键 词：慢性阻塞肺疾病 急性加重期 耐药性 病原菌 

分 类 号：R563[医药卫生—呼吸系统]