慢性阻塞肺病急性发作期下呼吸道分泌物病原学研究  

An etiology investigation of lower respiratory secretions during the acute phase of chronic obstructive pulmonary disease

作　　者：高岩[1] 王蓓[1] 卢献灵[1] 刘冬[1] 何小双[1] 张红梅[1] GAO Yan;WANG Bei;LU Xian-ling;LIU Dong;HE XIAO-shuang;ZHANG HONG-mei(The First Hospital Affiliated with the Shihezi University College of Medicine,Shihezi,Xinjiang,China 832008)

机构地区：[1]石河子大学医学院第一附属医院,新疆石河子832008

出　　处：《中国病原生物学杂志》2019年第12期1467-1470,1474,共5页Journal of Pathogen Biology

摘　　要：目的探究慢性阻塞肺病急性发作期下呼吸道分泌物病原学,预防患者感染,指导临床疾病治疗。方法收集206例慢性阻塞肺病急性发作期下呼吸道感染患者临床资料,鉴定患者感染病原菌类型,K-B法分析耐药性,并用PCR检测耐药基因。探究患者感染发生的影响因素,并经过统计学分析差异显著性。结果患者感染革兰阴性菌81株,革兰阳性菌22株,真菌5株。革兰阴性菌包括铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、其他分别为32、22、11.6和10株;革兰阳性菌包括金黄色葡萄球菌、肺炎链球菌肠球菌、其他分别为11.6、2和3株;真菌包括4株白色假丝酵母菌和1株热带假丝酵母菌。32株铜绿假单胞菌对哌拉西林、阿奇霉素、头孢他啶、庆大霉素、氨曲南、头孢吡肟、亚胺培南、妥布霉素、阿米卡星的耐药率分别为100.00%、50.00%、34.38%、28.13%、25.00%、21.88%、18.75%.15.63%和12.50%。11株金黄色葡萄球菌对利福平、克林霉素、替考拉宁、庆大霉素、万古霉素、红霉素、环丙沙星、苯唑西林、阿米卡星的耐药率分别为18.18%、45.45%、0.00%、36.36%、0.00%、63.64%、27.27%、36.36%和9.09%。铜绿假单胞菌中TEM、ant(2)-I、aac(6)-II、VEB、aac(6)-Ib、IMP基因的检出率分别为62.50%、28.13%、25.00%、21.88%、18.75%和15.63%。金黄色葡萄球菌中aac(6)-1/aph(2)、ermB、ermC、mecA.ermA.qacA基因的检出率分别为45.45%、.36.36%、27.27%、18.18%.9.09%和9.09%。长期应用抗生素、合并糖尿病、合并呼吸衰竭气管插管是影响感染发生的主要因素。结论感染病原菌类型以铜绿假单胞菌和金黄色葡萄球菌为主,病原菌耐药基因分布与耐药性关系密切。长期应用抗生素、合并糖尿病、合并呼吸衰竭、气管插管是影响感染发生的主要因素,临床应给予重视。Objective To investigate the etiology of lower respiratory secretions during the acute phase of chronic ob-structive pulmonary disease in order to prevent infections and guide clinical treatment of that disease.Methods Clinical data on 206 patients who developed a lower respiratory infection in the acute phase of chronic obstructive pulmonary dis-ease were collected to identify the type of pathogen,and the drug resistance genes were determined using PCR.The fac-tors influencing development of an infection were investigated,and data were statistically analyzed to reveal significant differences.Results Patients were infected with 81 strains of Gram-negative bacteria(75.00%),22 strains of Gram-positive bacteria(20.37%),and 5 strains of fungi(4.63%).Gram-negative bacteria included 32 strains of Pseudomonas aeruginosa(29.63%),22 strains of Klebsiella pneumoniae(20.37%),11 strains of Acinetobacter baumannii(10.19%),6 strains of Escherichia coli(5.56%),and 10 strains of other Gram-negative bacteria(9.26%).Gram-positive bacteria included 11 strains of Sta phylococcus aureus(10.19%),6 strains of Streptococcus pneumoniae(5.56%),2 strains of Enterococcus(1.85%),and 3 strains of other Gram-positive bacteria(2.78%)。Fungi included 4 strains of Candida albicans(3.70%)and 1 strain of C.tropicalis(0.93%).The 32 strains of P.aeruginosa were resistant to piperaillin at a rate of 100.00%,to azithromycin at a rate of 50.00%,to ceftazidime at a rate of 34.38%,to gentamicin at a rate of 28.13%,to aztreonam at a rate of 25.00%,to cefepime at a rate of 21.88%,to imipenem at a rate of 18.75%,to tobramycin at a rate of 15.63%,and to amikacin at a rate of 12.50%.The 11 strains of S.aureus were resist-ant to rifampicin at a rate of 18.18%,to clindamyein at a rate of 45.45%,to teicoplanin at a rate of 0.00%,to gentami-cin at a rate of 36.36%,to vancomycin at a rate of 0.00%,to erythromycin at a rate of 63.64%,to ciprofloxacin at a rate of 27.27%,to oxacillin at a rate of 36.36%,and to amikacin at a rate of 9.09%。The TEM gene was detected

关 键 词：慢性阻塞肺病 下呼吸道分泌物 病原学 耐药性 感染因素 

分 类 号：R378[医药卫生—病原生物学]