不同病程COPD并发下呼吸道感染病原菌分离及耐药情况分析#br#

目的 分析不同病程慢性阻塞性肺疾病(COPD)并发下呼吸道感染病原菌分布及其耐药性。方法 收集甘肃医学院附属医院2015年1月—2019年3月检出病原菌的COPD患者623例，根据COPD病程长短分为长病程组(＞10年)和短病程组(≤10年)，比较两组病原菌分布及耐药性情况。结果 长病程组和短病程组分别纳入281例和342例患者，各病程组病原菌均以革兰阴性菌为主。长病程组的革兰阴性菌和真菌分离率高于短病程组(P<0.05)。长病程组鲍曼不动杆菌、铜绿假单胞菌、产ESBLs菌株和CRE菌株的分离率均高于短病程组(P<0.05)。长病程组的病原菌对常见抗菌药物耐药率均高于短病程组。长病程组中，肺炎克雷伯菌对美罗培南耐药率最小(32.79%)，鲍曼不动杆菌对所有抗菌药物耐药率均大于50%，金黄色葡萄球菌对美罗培南和替加环素的耐药率小于30%；短病程组中，肺炎克雷伯菌对美罗培南、亚胺培南和莫西沙星的耐药率小于30%，鲍曼不动杆菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南的耐药率为30%左右；金黄色葡萄球菌对亚胺培南、美罗培南和替加环素的耐药率小于30%。两组均未分离出对万古霉素、利奈唑胺耐药的金黄色葡萄球菌。两组的白念珠菌对氟康唑耐药率较高，对伏立康唑和两性霉素B耐药率较小。结论 慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease，AECOPD)的病原菌以革兰阴性菌为主，病原菌构成及耐药性与COPD病程存在相关性，长病程组多重耐药菌株和真菌检出率高，耐药形式严峻。

Analysis of pathogen isolation and drug resistance in different course of COPD patients with lower respiratory tract infection#br#

Objective To observe the distribution and drug resistance in different course of COPD patients with lower respiratory tract infections. Methods A total of 623 COPD patients with lower respiratory tract infections who were detected the pathogens from Jan. 2015 to Mar. 2019 in Affiliated Hospital of Gansu Medical College were divided into the long-term disease group (>10 years) and the short-term disease group (≤10 years) by COPD course, and the distribution and drug resistance of the two groups of pathogens were compared. Results 281 patients were in the long-term disease group and 342 patients were in the short-term disease group, respectively. Gram-negative bacteria were the main pathogens in both groups, but the isolation rates of Gram-negative bacteria and fungi in the long-term disease group were higher than those in the short-course group (P<0.05). The isolation rates of Acinetobacter baumannii, Pseudomonas aeruginosa, ESBLs strains, and CRE strains in the long course group were higher than those in the short course group (P<0.05). The resistance rates of various pathogens to common antibiotics in long-term disease group were higher than those of short-term disease group. In the long-term group, the resistance rate of Klebsiella pneumoniae to meropenem was the lowest (32.79%), that of Acinetobacter baumannii to all antibiotics was more than 50%, those of Staphylococcus aureus to meropenem and tegacyclin was less than 30%. In the short course group, the resistance rates of Klebsiella pneumoniae to meropenem, imipenem, and moxifloxacin were less than 30%, those of Acinetobacter baumannii to cefoperazone/sulbactam, imipenem, and meropenem were about 30%; those of Staphylococcus aureus to imipenem, meropenem, and tegacyclin were less than 30%. No Staphylococcus aureus resistant to vancomycin and linezolid was isolated from the two groups. The resistance rate of Candida albicans to fluconazole was higher, and those to voriconazole and amphotericin B were lower in both group. Conclusion The pathogens of AECOPD patients with lower respiratory tract infections were mainly Gram-negative bacteria. The composition and drug resistance of pathogens were related to the course of COPD. The long-term disease group had a high detection rate of multi-drug resistant strains and fungi, and the drug resistance was severe.