慢性阻塞性肺疾病急性加重期患者病原菌分布特点

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者病原菌分布情况，为临床规范合理使用抗菌药物提供参考。 方法回顾性分析唐都医院呼吸与危重症医学科2014年01月至2017年10月住院的435例AECOPD患者病原菌分布特点。同时分析比较采用侵入性方法(纤维支气管镜)留取分泌物的149例患者及非侵入性方法(自然深部咳痰)留取分泌物的286例患者的病原菌检测情况。 结果275例(63.22%)患者分离出病原菌，其中单一病原菌感染241例，混合感染34例；混合感染中，细菌混合感染16例，细菌合并真菌感染18例。870份痰样本中，合格痰标本452份，占51.95%。共检出病原菌309株，阳性率为68.36%，G^＋ 60株(19.42%)，金黄色葡萄球菌24株、肺炎链球菌17株、溶血链球菌10株；G^－ 193株(62.45%)，铜绿假单胞菌56株、鲍曼/溶血不动杆菌36株、肺炎克雷伯27株；真菌56株(18.13%)，其中曲霉27株、白色念珠菌25株、热带念珠菌4株。149例患者侵入法留取分泌物分离出病原菌阳性者124例，检出136株病原菌，占83.22%；286例患者用非侵入法分离出病原菌阳性者151例，检出173株病原菌，占52.80%。 结论AECOPD患者以革兰阴性杆菌感染为主，主要是铜绿假单胞菌、鲍曼/溶血不动杆菌，但不能忽视真菌感染。支气管镜下吸取分泌物可显著提高病原菌检出率(P<0.01)，AECOPD患者两种方法留取分泌物培养均以G^－杆菌感染为主，病原菌分布无统计学差异。

Chronic obstructive pulmonary disease with acute aggravating period of etiology and drug resistance analysis

ObjectiveTo analysis of chronic obstructive pulmonary disease in patients with acute exacerbation period (AECOPD) pathogenic bacteria distribution and use of antibiotics and provide reference for rational use of antimicrobial drugs for clinical norms. MethodsIt was collected 435 patients with acute aggravating period of COPD data from January 2014 to October 2017 for nearly three years in XiAn Tang Du hospital studied bacteria distribution and drug resistance. Besides, it was Analysis and comparison pathogenic bacteria distribution of secretions with invasive methods fiberoptic bronchoscopy of 149 cases of patients and non-invasive methods (natural deep sputum) 286 patients. ResultsThe first, it was 275 patients (culture positive rate 63.22%) with isolated pathogenic bacteria, a single pathogen infection in 241 cases, 34 cases of mixed infection. Among them bacteria mixed infection in 16 cases, 18 cases of fungal infections bacteria merger. In 870 sputum samples, there were 452 sputum specimensthe qualified, accounting for 51.95%. All 309 strains pathogenic bacteria were isolated and cultured(detection positive rate 68.36%). with Gram-positive bacteria 60 strains(19.42%), staphylococcus aureus 24 strains, hemolytic streptococcus 17 strains, streptococcus pneumoniae 10 strains; Gram-negative bacteria 193 strains (62.45%), pseudomonas aeruginosa 56 strains, hemolytic acinetobacter bauman 36 strains, pneumonia klebsiella 27 strains; fungus 56 strains (18.13%), of which 27 strains aspergillus, 25 strains of candida albicans, 4 strains candida tropical. The secend, it was 124 patients with isolated pathogenic bacteria of 149 patients with invasion method to return secretion. There 136 strains of pathogenic bacteria were isolated and cultured, accounting for 83.22%. 286 patients with non-intrusive method isolated pathogenic bacteria was 151 cases. There 173 strains of pathogenic bacteria were isolated and cultured, accounting for 52.80%. ConclusionThe first, it is given priority to AECOPD patients with gram-negative bacteria infection, mainly by pseudomonas aeruginosa and bowman/hemolytic acinetobacter.But it can′t ignore fungal infection. The secend, taking secretion under bronchoscope increased significantly pathogen detection rate (P<0.01). Patients with AECOPD were mainly infection of gram-negative bacteria, pathogen distribution no difference.