2013-2017年黄石市中心医院中老年慢性阻塞性肺疾病急性加重期患者病原菌的分布及耐药性分析

目的 了解黄石市中心医院不同年龄段慢性阻塞性肺疾病急性加重（AECOPD）住院患者感染病原菌分布情况及耐药性特点。方法 分析黄石市中心医院2013年1月-2017年10月痰培养检出病原菌的554例AECOPD患者的病原菌分布和耐药性。结果 40~65岁和≥ 65岁患者均以革兰阴性菌为主，40~65岁患者排名前3位的病原菌分别为流感嗜血杆菌（18.54%）、铜绿假单胞菌（15.89%）和大肠埃希菌（13.58%）；≥ 65岁患者排名前3位的病原菌分别为铜绿假单胞菌（22.51%）、鲍曼不动杆菌（15.43%）和大肠埃希菌（14.15%）。≥ 65岁患者铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌的分离率显著大于40~65岁，流感嗜血杆菌、肺炎克雷伯杆菌和肺炎链球菌的分离率显著小于40~65岁，差异均有统计学意义（P<0.05）。≥ 65岁患者铜绿假单胞菌和大肠埃希菌的耐药率普遍大于40~65岁患者，其中铜绿假单胞菌对头孢他啶、左氧氟沙星、环丙沙星的耐药率和大肠埃希菌对哌拉西林他唑巴坦、头孢他啶、左氧氟沙星、环丙沙星的耐药率差异性均有统计学意义（P<0.05）。结论 黄石市中心医院AECOPD患者病原菌均以革兰阴性菌为主，但不同年龄段病原菌的构成和耐药性并不完全相同。依据不同年龄段患者病原菌分布及耐药性监测结果指导抗菌药物合理用药，是治疗AECOPD的关键。

Analysis on distribution and drug resistance of pathogens for patients with acute exacerbation chronic obstructive pulmonary disease in Huangshi City TCM Hospital from 2013 to 2017

Objective To understand the distribution and drug resistance of the pathogens for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in different age groups in Huangshi City TCM Hospital. Methods The distribution and drug resistance of pathogens detected by sputum culture of 554 cases of patients with AECOPD in Huangshi City TCM Hospital from January 2013 to October 2017. Results The main pathogens isolated from AECOPD patients with 40-65 years old and over 65 years old were Gram negative bacilli. The top of three pathogens of AECOPD patients with 40-65 years old were Haemophilus influenzae (18.54%), Pseudomonas aeruginosa (15.89%), and Escherichia coli (13.58%), and P. aeruginosa (22.51%), Bauman Acinetobacter (15.43%), and E. coli (14.15%) of AECOPD patients over 65 years old. The isolation rates of P. aeruginosa,B. Acinetobacter, and Stenotrophomonas maltophilia of AECOPD patients with over 65 years old were significantly greater than those of patients with 40-65 years old (P<0.05). The isolation rate of H. influenzae, Klebsiella pneumoniae, and S. pneumoniae of AECOPD patients over 65 years old were significantly less than 40-65 years old. The resistance rate of major Gram negative bacteria of AECOPD patients over 65 years old was greater than those of 40-65 years old, and there were significant difference in resistance rate of P. aeruginosa for ceftazidime, levofloxacin, ciprofloxacin, and E. coli for piperacillin, tazobactam, ceftazidime, levofloxacin, and ciprofloxacin between two age groups (P<0.05). Conclusion Gram-negative bacilli are the most common pathogens in the AECOPD patients in Huangshi City TCM Hospital, however, the composition and resistance of pathogenic bacteria in different age groups are not exactly the same. According to the distribution of pathogenic bacteria and drug resistance monitoring results of different age groups to guide rational use of antibiotics is the key to the treatment of AECOPD.