254例慢性阻塞性肺病急性加重期细菌学及药敏分析

目的探讨慢性阻塞性肺病（COPD）急性加重期病原菌及药物敏感性，为临床合理选择抗生素提供依据。方法回顾性分析我院254例慢性阻塞性肺病急性加重期患者，收集痰标本进行细菌培养及鉴定，并对培养细菌进行药物敏感性分析。结果共检出致病菌262株，其中G-杆菌182株，占69．5％；G＋球菌38株，占14．5％；真菌24株，占9．1％；其他菌株18株，占6．9％。药敏分析发现G-菌对亚胺培南最为敏感，其次为氨曲南，然后为二代以上头孢菌素，包括头孢噻肟、头孢哌酮、头孢他啶等，对一代头孢菌素及青霉素敏感性较低，对万古霉素耐药。G＋菌对亚胺培南、万古霉素及氨曲南敏感性强，对青霉素类及头孢菌素类的敏感性普遍较低。结论COPD急性加重期病原菌复杂多变，多以肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、产气肠杆菌等G-菌为主，对亚胺培南最敏感；其次为G＋球菌，以金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌为主，对亚胺培南、万古霉素的敏感性最强。

Bacteriological and drug sensitivity analysis of 254 patients with chronic obstructive pulmonary disease in acute exacerbation period

Objective To explore the pathogenic bacteria and drug sensitivity of chronic obstructive pulmonary disease(COPD)in acute exacerbation period,and to provide evidence for reasonable selection of antibiotics in clinic.Methods Retrospective analysis was made in 254 patients with COPD in acute exacerbation period.Their sputum specimens were collected for germiculture and identification.The drug sensitivity of the cultured bacteria was analyzed.Results Totally 262 strains of bacteria were detected.There were 182 strains of G-bacillus(69.5%),38 strains of G+ coccobacteria(14.5%),24 strains of fungi(9.1%)and 18 other strains(6.9%).The drug sensitive analysis showed that G-bacillus was the most sensitive to imipenem and then aztreonam and cephalosporin above the 2nd generation including cefotaxim,cefoperazone,ceftazidime,etc.It had lower sensitivity to cephalosporin of 1st generation and penicillins,and had drug resistance against vancocin.G+ coccobacteria were strongly sensitive to imipenem,vancocin and aztreonam,but generally had lower sensitivity to penicillins and cephalosporin.Conclusion The pathogenic bacteria of COPD in acute exacerbation period are complex and diversified.The main bacteria are G-bacillus,such as klebsiella pneumoniae,pseudomonas aeruginosa,baumanii,colibacillus,enterobacter aerogenes,etc,which are most sensitive to imipenem.The next are G+ coccobacteria including mainly staphylococcus aureus,staphylococcus epidermidis,streptococcus pneumoniae,which are most sensitive to imipenem and vancocin.