2008-2012年天津市第一中心医院老年慢性阻塞性肺疾病急性加重期病原菌的分布及耐药性分析

目的了解老年慢性阻塞性肺疾病急性加重期（AECOPD）患者病原菌分布特点及耐药情况，为临床合理应用抗菌药物提供理论依据。方法对天津市第一中心医院呼吸科病房2008年1月-2012年12月老年AECOPD患者痰标本分离确认的121株病原菌构成及耐药性进行统计分析。结果共分离病原菌121株，其中革兰阴性菌84株（占69．4％），主要有铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼不动杆菌和阴沟肠杆菌；革兰阳性菌共24株（占19．8％）。药物敏感实验结果显示，碳青霉烯类抗菌药物对主要革兰阴性杆菌仍保持较高的敏感性，但革兰阴性杆菌对常用β-内酰胺类药物的耐药性明显增加。结论老年AECOPD患者感染以革兰阴性杆菌为主，且耐药严重。早期经验性选择抗菌药物应选择敏感性相对较高的药物，并根据药敏结果选择敏感药物，以减少耐药菌株的产生。

Analysis on distribution and drug resistance of elderly patients with acute exacerbation of chronic obstructive pulmonary disease in Tianjin First Central Hospital from 2008 to 2012

Objective To analyze the distribution and drug resistance of pathogens in elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, and to provide the reliable basis for the clinical rational use of drug. Methods Constitution and drug resistance of 121 strains from the sputum specimen of elderly patients with AECOPD from January, 2008 to December, 2012 in the Respiratory Department of Tianjin First Central Hospital were analyzed, retrospectively. Results Totally 121 strains of bacteria were isolated, including 84 （69.4%） strains of Gram-negative bacilli among which Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Enterobacter cloacae, were dominant and 24 （19.8%） stains of bacteria was Gram-positive bacilli. Drug susceptibility testing showed that Gram-negative bacilli were sensitive to antibiotics of Carbapenem, while Gram-negative bacilli were resistant to β-lactamases. Conclusion The pathogens in elderly patients with AECOPD are mainly composed of Gram-negative bacteria and show the high resistance to antibiotics. Drugs with the relatively high sensitivity should be selected in early treatment, and the selection of antibiotics should be based on the results of drug sensitivity test, so as to reduce the generation of resistant strains.