慢性阻塞性肺病下呼吸道感染病原菌和耐药性分析

目的：总结慢性阻塞性肺病(COPD)下呼吸道感染病原菌和耐药性的特点。方法：回顾性分析近一年本院收治的明确诊断为COPD的患者痰标本细菌培养和药敏报告。结果：COPD急性发作期下呼吸道感染以革兰氏阴性杆菌为主，占70.6％．主要有肺炎克雷伯杆菌、流感嗜血杆菌、绿脓杆菌和大肠杆菌等．ESBLs阳性率达26．5％；革兰氏阳性菌占29．4％。以金黄色葡萄球菌和表皮葡萄球菌为主。21.9％的患者有2种以上细菌混合感染。32．3％的患者合并真菌感染。药敏显示大多数革兰氏阴性杆菌对三代头孢、氟喹诺酮类、氨基糖苷类、氧哌嗪青霉素和阿莫西林 棒酸等抗生素比较敏感。泰能对ESBLs阳性的细菌敏感率达100％，而由β—内酰胺酶抑制剂组成的复合制剂的敏感率较低。革兰氏阳性球菌的耐药性较高，除万古霉素高度敏感外，对其它抗生素均呈现不同程度耐药。结论：C0PD急性发作期下呼吸道感染以革兰氏阴性杆菌多见，常有多种细菌混合感染，又耐药现象严重，临床医师应重视革兰氏阴性杆菌的治疗，合理应用抗生素，控制呼吸道的感染。

Pathogen and drug-resistance analysis of lower-respiratory-tract bacterial infection in chronic obstructive pulmonary disease

Objective: To summarize the character of pathogen and drug resistance of lower-respiratory-tract bacterial infection in chronic obstructive pulmonary disease (COPD). Methods: To analyze the report of bacterial cultures of sputum and drug sensibility in final diagnosis COPD patients retrospectively. Results: Gram-negative bacteria (GNB) is more common in COPD patients, most of the bacteria were klebsiella pneumoniae?Haemophilus influenzae Bacillus?Pseudomonas aeruginosa and Escherichia coli,thirteen extended-spectrum -lactamases(ESBLs) positive strains of enterobacter were isolated from 49 patients. Staphylococcus aureus is most in gram-positive bacteria (GPB). 21 patients (21.9%) were infected by two or more kinds of becteria. Drug sensitivity test showed that ceftazidime?cefoperazone?vancomycin?Ciprofloxacin?aminogiycosides?piperacillin?tienam were effective drugs. Conclusion: GNB were more common bacteria in COPD acute episode stage and drug resistance rate of microbe was very severity . So drug resistance test should be done more often and antibiotics must be selected according to the test.