慢性肺心病急性加重期病菌及药敏试验结果分析

目的探讨１９７８～１９９８年老年慢性肺心病急性加重期痰菌培养结果及药物敏感试验情况。方法晨起咳出痰留作标本，病原菌检查采用定量培养技术，２次及以上培养出同一菌种者视为病原菌。同时作药敏试验。结果前期组（１９７８～１９８８年）及后期组（１９８９～１９９８年）两组病原菌比较。前期组以革兰阳性球菌为主，占５７％，后期组革兰阴性杆菌跃为首位，占８２７％。药敏试验结果：革兰阳性球菌对青霉素、氨苄青霉素、红霉素耐药，而对氧哌嗪青霉素、头孢唑啉较敏感。革兰阴性杆菌对氨苄青霉素、链霉素、头孢唑啉等耐药；对氨基糖甙类、喹诺酮类及第二、三代头孢菌素较敏感。结论前后期病原菌的变迁，与当前更早期，广泛应用抑制球菌的抗生素有关，气管插管或切开损伤气道粘膜及医疗器械广泛应用，增加气道感染机会，再加上老年肺心病患者，防御功能减弱及免疫功能低下，导致细菌变迁。

Evaluation of bacterial culture and antibiotic sensitivity in acute exacerbation of chronic cor pulmonale

Objective To evaluate the results of sputum culture and antibiotic sensitivity in acute exacerbation of senile chronic cor pulmonale admitted from 1978 to 1998. Methods Sputum was collected in the morning and the quantitative cultural technique was used.In a patient,when the same bacterial,strain was obtained for 2 times,it was considered Ptiologic.The first group included patients from 1978 to 1988 and the second group from 1989 to 1998. Results In the first group,gram positive cocci appeared to be the leading factor(54 7%)In the sceond group,gram negative bacillus increased to 77 5%.Gram positive cocci were resistant to penicilin G,carpenicillin and erythromycin,but sensitive to piperacillin and cefazolin.Gram negative bacilli were resistant to carpenicillin,streptomycin and cefazolinm,but sensitive to aminoglycosides,the second and third generation of cephalosporins and 4 quinolones. Conclusions The change in etiologic bacteria was related to the early and extensive application of anticoccal drags.The injury from endotracheal catheter and tracheotomy and other medical instruments increased the chances of tracheal infection.The reduction in defensive and immunological functions also may play some roles in the change in etiologic bacteria.