老年慢性阻塞性肺疾病急性加重期细菌分布及耐药性分析

目的了解慢性阻塞性肺疾病急性加重期（acuteexacerbationofchronicobstructivepulmonarydiseases．AECOPD）患者病原菌分布特点及耐药情况，指导临床合理用药。方法对武警重庆总医院2008年1月～2011年1月的220例患者痰培养结果及药物敏感实验结果进行回顾性分析。结果220例患者共分离出病原菌256株，以革兰氏阴性菌为主，共212例，占82．8％，依次是肺炎克雷白杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌等等，对第三代头孢菌素耐药严重，碳青霉烯类抗生素仍是敏感性最高的药物，其次为哌拉两林／他唑巴坦、头孢哌酮／舒巴坦、阿米卡星。结论AECOPD患者下呼吸道感染以革兰氏阴性杆菌为主，且耐药较严重，早期经验性选择抗菌药物应选择敏感性相对较高药物，应根据药敏结果选择敏感药物，减少耐药菌株的产生。

Study on bacterial distribution and drug resistance of elderly patients with acute excarbation of chronic obstructive pulmonary diseas

Objective To investigate the distribution and antibiotic resistance of pathogens in patients with acute ex- acerbation of chronic obstructive pulmonary diseases （AECOPD） and to guide rational clinical drug use. Methods Retro- spective analysis was performed in sputum culture and drug susceptibility test results of 220 elderly patients who were in Chongqing Corps Hospital of Chinese Armed Police Forces from January 2008 to January 2011. Results A total of 256 strains of microorganisms were isolated from 220 cases, Gram-negative bacteria accounted for 82.8 %, includingK, pneu- moniae, P. aeruginosa, Acinetobacter spp., E. coil, etc. Susceptibility testing showed that gram-negative bacteria were highly resistant to third generation cephalosporins, but relatively susceptible to carbapenems and piperacillin-tazobactam and Cefopcrazone -Sulbactam and amikacin. Conclusions The main pathogens in lower respiratory tract infection in AECOPD patients are gram-negative bacteria and show highly resistant to antibiotics. Early experiential antibiotic utilization should be selected relatively high sensitivity of drugs. On the other hand, long time use of broad-spectrum antibiotics medicine should be banned and to reduce the emergence of drug-resistant strains. Selection of antibiotics should be based on results from susceptibility test.