慢性阻塞性肺疾病急性发作期病原菌及耐药性分析

目的:总结我院慢性阻塞性肺疾病急性发作期(AECOPD)患者下呼吸道感染病原菌分布和耐药性特点,指导抗生素应用。方法:对我院2003年7月1日至2004年12月31日呼吸科收治的258例AECOPD患者行痰液细菌培养,药敏采用纸片扩散法。结果:258例AECOPD患者痰细菌培养分离出251株致病菌,以革兰阴性杆菌居首位(77.3%),真菌第2位(12.4%),革兰阳性球菌第3位(10.4%)。革兰阴性杆菌中以铜绿假单胞菌(38.1%)、嗜麦芽窄食单胞菌(16.0%)、不动杆菌(12.9%)、洋葱伯克霍尔德氏菌(7.2%)为主要致病菌。革兰阳性球菌中以金黄色葡萄球菌(34.6%)、表皮葡萄球菌(23.1%)、肺炎链球菌(19.2%)为主要致病菌。药敏发现,对铜绿假单胞菌抗菌活性较强的有头孢他啶、头孢哌酮/舒巴坦;对嗜麦芽窄食假单胞菌抗菌活性较强的有环丙沙星、头孢哌酮/舒巴坦;对不动杆菌较敏感的有泰能、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦;对洋葱伯克霍尔德氏菌敏感的有复方新诺明、泰能。阿米卡星、万古霉素对大部分革兰阳性球菌敏感。结论:AECOPD下呼吸道致病菌以革兰阴性杆菌为主,且耐药率较高。AECOP...

Distribution and drug resistance of pathogens in respiratory tract of patients with acute exacerbation chronic obstructive pulmonary disease

Objective To analyze the distribution of pathogens in respiratory tract and their drug resistance in the patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) for a better use of antibiotics in treatment. Methods The sputum samples of AECOPD patients from July 2003 to December 2004 were collected from our hospital and the pathogens species were found in all sputum samples. The drug sensitivity were determined by K- B paper method. Results Two hundred- fifty- one strains of pathogens were found in all sputum samples, of which 77.3% were Gram- negtive, 10.4% Gram- positive, and 12.4% epiphytes. Among the Gram- negtive bacillis, the main pathogens included Pseudomonas (38.1% ), Stenotrophomonas (16.0% ), Acinetobacter (12.9% ) and Burkholderia (7.2% ). Among the Gram- positive coccis, the main pathogens included Staphyloccus aureus (34.6% ), Staphyloccus epidermindis (23.1% ), and Pneumococcus (19.2% ) . The results of drug sensitivity test showed that Pseudomonas were more sensitive to cefoperazone/sulb and ceftazidime, Stenotrophomonas to cefoperazone/sulb and ciprofloxacin, Acinetobacter to imipenem, meropenem, cefoperazone/sulb and piperacillin/Tazo, Burkholderia to SMZ- co, imipenem, and that most of the Gram- positive coccis were more sensitive to amikacin and vancomycin. Conclusions Gram- negative bacillus are predominant in lower respiratory tract in AECOPD patients with higher frequency of drug resistance. Antibiotics collected for AECOPD must be according to the susceptibility test results.