慢性阻塞性肺病急性加重期并肺部感染老年患者痰液的细菌培养及药敏分析

目的：分析老年慢性阻塞性肺疾病急性加重期（AECOPD）患者痰培养的病原菌菌型及药敏情况。方法：回顾分析2009年我院呼吸科150例老年AECOPD患者痰标本细菌培养和药敏报告，并对革兰阴性杆菌（GNB）进行菌型分析。结果：150例AECOPD患者共作201次痰培养，阳性为120例，阳性率为80．00％，其中，G曙6株，G＋45株，真菌4株。其中单一病原菌占78．70％，复合病原菌占21．30％。主要为革兰阴性菌，占63．70％，革兰阳性菌占33．33％，真菌占2．96％。GNB中铜绿假单胞菌占27．91％，流感嗜血杆菌占11．63％，副流感嗜血杆菌占13．95％，肺炎克雷伯菌27．91％，阴沟肠杆菌占12．79％。革兰阳性菌中肺炎链球菌占71．11％，表皮葡萄球菌占28．89％，GNB以肺炎克雷伯菌、铜绿假单胞菌为主，革兰阳性菌以肺炎链球菌为主，但相对于GNB来说，细菌分布的种类以及程度较低。抗生素中头孢曲松钠对GNB和阳性菌均有效，并且耐药性低，耐药菌的种类少。结论-0）GNB是老年慢性阻塞性肺疾病急性加重期住院期间主要的致病菌。②临床需结合慢性阻塞性肺疾病稳定期及老年患者发病特点选择使用抗生素，从而更好地控制细菌感染，避免经验性用药导致的抗生素耐药，有效缓解患者的症状。③当患者未能明确感染细菌种类时。头孢曲松钠对GNB或是革兰阳性菌都有抗菌作用，可以推荐作为常规经验用药。④亚胺培南虽然是比较高级的药物，但是对GNB感染并非全部敏感，要根据抗菌谱选择性使用，避免耐药几率的上升。

Sputum bacterial training and medicine sensitivity analysis of elderly patients with acute exacerbation of COPD

Objective： To analyze the sputum bacterial training and medicine sensitivity of elderly patients with acute ex- acerbation of COPD （AECOPD）. Methods： To review sputum bacterial training and medicine sensitivity of 150 cases of elderly AECOPD patients in 2009, and with sputum specimens germi culture and drug susceptibility report, and against gram-negative bacilli （GNB） bacteria type analysis. Results： 150 cases of AECOPD patients were given 201 times sputum cultures, positive in 120 patients, account for 80.00%, among them, G- in 86 strains, G＋ 45 in strains, fungi in 4 strains. In which single pathogen account for 78.70% and composite pathogen account for 21.30%. The gram-negative bacterium accounting for 63.70%, gram-positive organisms accounted for 33.33%, fungal accounted for 2.96%. In gram-negative bacterium pseudomonas, pseudomonas aeruginosa account for 27.91%, haemophilus influenzae for 11.63%, deputy of haemophilus influenzae accounted for 13.95%, pneumonia crayresearch 27.91%, enterobacter cloacae accounted for 12.79%. In grampositive bacterium, streptococcus pneumoniae accounted for in 71.11%, staphylococcus epidermidis accounted for 28.89%, gram-negative bacterium to pneumonia crayresearch bacteria, pseudomonas aeruginosa, gram-positie organisms to give priority, but the bacteria and types distribution were low. Antibiotics ceftriaxone sodium in gram-negative bacteria and positive bacteria were valid, and resistance was low, species was less. Conclusion： ①Gram-negative bacilli is main pathogenic bacteria of AECOPD of old patients. ②Clinic should choose to use antibiotic according to eharacteristies of old patients, in order to control bacterial infection better, avoid use antibiotic in experience, and alleviate the symptoms effectively, ③When the patient failed to clear the infection types of bacteria, the eeftriaxone against gram-negative bacteria or gram-positive bacteria have antibacterial activity, the experience can be recommended as routine treatment. ④Although imipenem is more advanced drugs, but not Gram-negative bacterial infections sensitive to all, according to the selective use of antimicrobial spectrum, to avoid the rising risk of drug resistance.