老年慢性阻塞性肺疾病合并肺部感染患者病原菌感染分布、耐药情况及基因型分析  

Analysis of distribution,drug resistance and genotype of pathogenic bacteria in elderly patients with COPD complicated with pulmonary infection

作　　者：任燕 王璋 石晓荣 Ren Yan;Wang Zhang;Shi Xiaorong(Second Ward,Department of Cadre Ward III,General Hospital of Western Theater Command,Chengdu,Sichuan,610083,R.P.China)

机构地区：[1]西部战区总医院干部病房三科二病区,四川成都610083

出　　处：《老年医学与保健》2025年第1期157-160,165,共5页Geriatrics & Health Care

基　　金：四川省干部保健科研课题(川干研2021-1301)。

摘　　要：目的分析老年慢性阻塞性肺疾病(COPD)合并肺部感染患者病原菌感染分布、耐药情况及基因型。方法回顾性收集2020年8月—2024年8月在西部战区总医院治疗的140例老年COPD合并肺部感染患者的临床资料,患者均接受病原学检查、药敏试验及耐药菌基因型检测等。结果140例老年COPD合并肺部感染患者中,经痰培养分离病原菌153株,以革兰阴性菌菌株为主,共77株,占比50.33%,其中以肺炎克雷伯杆菌菌株数占比最高,达26.80%,其次为大肠埃希菌与铜绿假单胞菌,分别占比为13.07%和8.50%。41株肺炎克雷伯杆菌对碳青霉烯、喹诺酮类以及β内酰胺酶抑制剂复方制剂等抗生素较为敏感,耐药率均低于20%,其中以亚胺培南、美罗培南等碳青霉烯类抗生素敏感性相对最高,耐药率均低于10%。但肺炎克雷伯杆菌对头孢菌素类、四环素类抗生素耐药性较高,其中以头孢唑林、头孢曲松等头孢菌素类抗生素耐药性相对最高,耐药率均高于30%。41株肺炎克雷伯杆菌耐菌有39株检测出耐药基因,耐药基因检出率为95.12%,其中以携带TEM基因占比最高,达38.46%,其次为携带CTX-M-8基因,达20.51%。结论革兰阴性菌可能是老年COPD合并肺部感染患者中占比最高的感染菌,其中以肺炎克雷伯杆菌为主,其耐药现象较为严峻,对头孢菌素类以及四环素类等抗生素均存在较高耐药性,且耐药基因主要以携带TEM、CTX-M-8等类型为主。Objective To analyze the distribution,drug resistance and genotypes of pathogenic bacteria in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection.Methods The clinical data from 140 elderly COPD patients with pulmonary infections treated in General Hospital of Western Theater Command from August 2020 to August 2024 were retrospectively collected.All patients underwent etiological examination,drug sensitivity test,and genotype test for drug-resistant bacteria.Results Among the 140 patients,153 strains of pathogenic bacteria were isolated via sputum culture,and most of them were Gram-negative bacteria(77 strains,50.33%).Among them,the proportion of Klebsiella pneumoniae was the highest(26.80%),followed by Escherichia coli(13.07%)and Pseudomonas aeruginosa(8.50%).41 strains of Klebsiella pneumoniae were sensitive to carbapenems,quinolones and beta-lactam inhibitor compound preparations,and the resistance rates were lower than 20%.The sensitivity to carbapenems such as imipenem and meropenem was the highest,and the resistance rates were lower than 10%.However,Klebsiella pneumoniae was highly resistant to cephalosporins and tetracyclines.The resistance to cephalosporins such as cefazolin and ceftriaxone was the strongest,and the resistance rates were higher than 30%.Among 41 strains of Klebsiella pneumoniae,39 strains had drug resistance genes,with a detection rate of 95.12%.Among them,the proportion of strains carrying TEM gene was the highest(38.46%),followed by those carrying CTX-M-8 gene(20.51%).Conclusion Gram-negative bacteria,particularly Klebsiella pneumoniae,are the predominant pathogens in elderly COPD patients complicated with pulmonary infections.Its resistance is severe,with high resistance to cephalosporins and tetracyclines.TEM gene and CTX-M-8 gene are main drug resistance genes.

关 键 词：老年 慢性阻塞性肺疾病 肺部感染 肺炎克雷杆菌 耐药情况 基因型 

分 类 号：R56[医药卫生—呼吸系统]