慢性阻塞性肺疾病患者肺部感染病原菌分布及抗菌药物使用情况分析  

Analysis of pulmonary infection pathogen distribution and antimicrobial drugs use in patients with chronic obstructive pulmonary disease

作　　者：王欣如 杜连佳 王孝天 WANG Xinru;DU Lianjia;WANG Xiaotian(Department of Pharmacy,the First Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui,233000,China)

机构地区：[1]蚌埠医科大学第一附属医院药剂科,安徽蚌埠233000

出　　处：《当代医学》2025年第1期124-128,共5页Contemporary Medicine

摘　　要：目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肺部感染病原菌分布及抗菌药物使用情况。方法选取2021年6月至2023年6月蚌埠医科大学第一附属医院收治的140例COPD患者作为研究对象,采集患者痰标本,通过分析谱指数(analytical profile index,API)系统分析肺部感染病原菌,统计患者抗菌药物使用情况,通过Kirby-Baure法进行药敏试验,探讨各病原菌对抗菌药物的耐药性。结果140例患者的痰标本共分离菌株183株。其中,以革兰阴性菌检出最多,为114株(62.29%),包括大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌及阴沟杆菌等;革兰阳性菌60株(32.79%),包括金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌等;真菌9株(4.92%)。140例患者共使用抗菌药物>12种,共使用225次,其中,左氧佛沙星的使用次数最多,使用较少的药物为阿米卡星、环丙沙星与氨曲南等。5种革兰阳性菌对多数抗菌药物存在耐药性,其中,金黄色葡萄球菌对各类药物的耐药性最高,对青霉素的耐药性为96.00%、庆大霉素耐药性为88.00%、阿奇霉素耐药性为64.00%,对万古霉素未呈现耐药性;肠球菌对各类药物的耐药性相对较低,对青霉素的耐药性为83.33%、庆大霉素耐药性为66.67%、阿奇霉素耐药性为50.00%,对万古霉素未呈现耐药性。5种主要革兰阴性菌对各类抗菌药物均存在不同程度耐药性,其中,铜绿假单胞菌对各类药物的耐药性最高,对左氧氟沙星的耐药性为86.95%、头孢唑啉的耐药性为82.61%、阿莫西林-克拉维酸的耐药性为78.26%,对阿米卡星的耐药性最低,为9.09%;其余各类主要革兰阴性菌均对各类药物呈现不同程度的耐药反应。结论COPD患者肺部感染病原菌种类繁多且抗菌类药物使用频率高,各类病菌普遍具有耐药性,临床治疗中应根据患者药敏试验结果选择相应抗菌药物,以提升治疗效果,降低耐药�Objective To analyze the distribution of pathogenic bacteria and antimicrobial drugs use in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 140 patients with COPD treated in the First Affiliated Hospital of Bengbu Medical University from June 2021 to June 2023 were selected as the research subjects,sputum samples were collected for analysis of pulmonary infection pathogens,antimicrobial usage through analytical profile index(API)system,and drug susceptibility test by Kirby-Baure method,the resistance of pathogenic bacteria to antibiotics were investigated.Results A total of 183 strains were isolated from 140 patients'sputum samples.Among them,the gram-negative bacteria were the most detected,which was 114 strains(62.29%),including Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae and Clobacillus,etc;there were 60 gram-positive strains(32.79%),including Staphylococcus aureus,Staphylococcus haemolyticus,Staphylococcus epidermidis,etc;there were 9 fungal strains(4.92%).In 140 patients,>12 kinds of antibiotics were used,a total of 225 times,among which levofloxacin was used the most frequently,less used drugs were amikacin,ciprofloxacin and amtronam.The 5 gram-positive bacteria showed resistance to most antibiotics,among which Staphylococcus aureus showed the highest resistance to various drugs,with 96.00%resistance to penicillin,88.00%resistance to gentamicin,64.00%resistance to azithromycin,and no resistance to vancomycin.The resistance of Enterococcus to various drugs was lower,and the resistance to penicillin was 83.33%,the resistance to gentamicin was 66.67%,the resistance to azithromycin was 50.00%,and the resistance to vancomycin was not shown.5 major gram-negative bacteria had different degrees of resistance to various antibiotics,among which Pseudomonas aeruginosa had the highest resistance to various drugs,with 86.95%resistance to levofloxacin,82.61%resistance to cefazolin and 78.26%resistance to amoxicillin and clavulanate,amikacin resistance

关 键 词：慢性阻塞性肺病 肺部感染 病原菌 抗菌药物 耐药性 

分 类 号：R563.9[医药卫生—呼吸系统]