慢性阻塞性肺疾病急性加重患者下呼吸道细菌学分析

目的 了解慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道病原体的构成及耐药率,指导临床治疗；方法 对2012年9月～2013年3月住院的COPD急性加重期的196例患者下呼吸道痰液进行细菌培养、鉴定及药敏试验,抽取静脉血检测呼吸道九联病原体的IgM;结果 196位患者分离到148株菌,其中革兰阴性杆菌58株(39％),依次是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌；革兰阳性球菌12株(8％),主要是金黄色葡萄球菌和肺炎链球菌；真菌78株(53％),其中以白假丝酵母菌为多,占64％.药敏结果提示革兰阴性杆菌对头孢3代耐药率高,对碳青霉烯类敏感性高.呼吸道病原九联检只有4例肺炎支原体阳性. 结论 AECOPD患者的下呼吸道病原体以革兰阴性杆菌为主,耐药率逐年升高,二重感染增加.在临床实践中,需注意选择适当的抗革兰阴性杆菌治疗,并注意真菌感染,减少细菌耐药性和减少二重感染.

Detection of pathogens in patients with chronic obstructive pulmomary diseases at actue exacerbation stage

Objective To investigate the distribution and antibiotic resistance of bacterial pathogens in patients with chronic obstructive pulmomary diseases （AECOPD）at actue exacerbation stage. Methods Sputum and venous blood were collected from 196 patients with AECOPD hospitalized from September 2012 to March 2013 in Haikou Municipal People＇s Hospital. The pathogens were identified and the susceptibility test were conducted. Results Totally 148 strains of micro-organisms were isolated from 196 patients. Gram-nagtive bacteria were 51 strains （39%）,including P. aeruginosa, banmanii,K, pneumoniae,E.coli; Gram- postive bacteria belonged to 12 strains（8%）, including S. aureus and S. pneumonia; there were also 78 Fungi stains （38%）,and C. albicans predominated occupied 25%. Gram-nagtive bacteria were highly resistant to third generation cephalosporin; but susceptible to carbapenem. The only 4 Mycobacterium pneumonia were detected. Conclusion Gram-nagtive bacteria were the main bacterial pathogen of AECOPDs in patients with chronic obstructive pulmomary diseases at acutee exacerbation,The resistance of bacrteria to antibiotics increases year by year,Thus drug sensitivity test be carried out to_guide reasable use of antibiotic.