慢性阻塞性肺疾病患者呼吸道感染致病菌分布及耐药性分析  

Distribution of pathogens causing respiratory tract infections and antimicrobial resistance among patients with chronic obstructive pulmonary disease

作　　者：童林荣 肖路生 康美玲 周珍 林丽芳 许雅红 TONG Linrong;XIAO Lusheng;KANG Meiling;ZHOU Zhen;LIN Lifang;XU Yahong(Department of Respiratory Medicine,The 73th Group Military Hospital of People's Liberation Army,Xiamen,Fujian 36100l,China)

机构地区：[1]中国人民解放军陆军第七十三集团军医院呼吸内科,福建厦门361001

出　　处：《中国病原生物学杂志》2024年第11期1349-1353,共5页Journal of Pathogen Biology

基　　金：福建省厦门市科技计划指导性项目(No.3502Z20214ZD1193)。

摘　　要：目的分析慢性阻塞性肺疾病(COPD)合并呼吸道感染患者的致病菌分布,测定分离的主要病原菌对抗菌药物的敏感性。方法以2021年5月至2024年4月本院呼吸内科接受诊治的COPD且有呼吸道感染的病例为研究对象。无菌采集痰液样本,采用VITEK2 Compact全自动微生物分析系统鉴定病原菌,采用圆纸片扩散试验测定分离的主要细菌菌株对常见抗菌药物的敏感性。结果累计采集的288份痰液样本中,157份痰培养阳性,阳性率为54.51%。分离的病原菌以革兰阴性菌为主,占74.52%;革兰阳性菌和真菌分别占23.57%和1.91%。肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和嗜麦芽假单胞菌为分离的主要革兰阴性菌菌种,分别占分离的病原菌菌株总数的19.75%、17.20%、14.65%和13.38%;金黄色葡萄球菌为分离的主要革兰阳性菌菌种,占分离的病原菌菌株总数的19.75%。肺炎克雷伯菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、氨曲南耐药率均为100.00%;鲍曼不动杆菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉耐药率均为100.00%;铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢曲松和复方新诺明耐药率均为100.00%,对阿米卡星和庆大霉素敏感率均>95%;嗜麦芽假单胞菌对头孢吡肟耐药率>70%,对左旋氧氟沙星敏感率均>90%。金黄色葡萄球菌对利奈唑胺、呋喃妥因、利福平、奎奴普丁/达福普汀和替加环素100.00%敏感,但对青霉素G耐药率较高(96.77%)。结论COPD伴呼吸道感染病例致病菌以革兰阴性菌为主。革兰阳性菌对利奈唑胺、呋喃妥因、利福平、奎奴普丁/达福普汀、替加环素敏感性仍较高,但对青霉素G耐药率较高;主要革兰阴性菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉耐药性普遍较高。Objective e To identify the species of pathogens causing respiratory tract infections among patients with chronic obstructive pulmonary disease(COPD),and to test the susceptibility of bacterial isolates to common antimicrobial agents.Methods COPD patients with respiratory tract infections admitted to Department of Respiratory Medicine of a hospital during the period from May 2021 to April 2024 were recruited.Sputum samples were collected under sterile conditions,and the pathogen species were characterized using the VITEK2 Compact fully automated microbial analysis system.In addition,the susceptibility of major bacterial isolates to common antimicrobial agents was tested using the K-B disk diffusion test.Results A total of 288 sputum samples were collected,and 157 samples were cultured positive for pathogens,with a positive rate of 54.51%.Gram-negative bacteria were dominant among bacterial isolates(74.52%),and the proportions of Gram-positive bacteria and fungi were 23.57%and 1.91%,respectively.Klebsiella pneumonia(19.75%of all pathogens),Acinetobacter baumanni(17.20%of all pathogens),Pseudomonas aeruginosa(14.65%of all pathogens)and Pseudomonas maltophilia(13.38%of all pathogens)were dominant Gram-negative bacterial isolates,and Staphylococcus aureus was the dominant Gram-positive bacterial isolate(19.75%of all pathogens).The prevalence of resistance to ampicillin,ampicillin/sulbactam,cefazolin and aztreonam was 100.00%in K.pneumonia,and A.baumannii showed 100.00%resistance to ampicillin,ampicillin/sulbactam and cefazolin,while P.aeruginosa showed 100.00%resistance to ampicillin,ampicillin/sulbactam,cefazolin,ceftriaxone and sulfamethoxazole and>95%susceptibility to amikacin and gentamicin.In addition,P.maltophilia showed>70%resistance to cefepime and>95%susceptibility to levofloxacin,while S.aureus was 100.00%susceptible to linezolid,nitrofurantoin,rifampicin,quinupristin/dalfopristin and tigecycline and showed high resistance to penicillin G(96.77%prevalence of resistance).ConclusionGram-negative bacteria are

关 键 词：呼吸道感染 致病菌 耐药性 慢性阻塞性肺疾病 

分 类 号：R446.5[医药卫生—诊断学] R563.9[医药卫生—临床医学]