AE-COPD致病菌的耐药情况分析及抗菌治疗对策

目的：总结我院慢性阻塞性肺疾病急性发作期（AE-COPD）患者下呼吸道感染病原菌分布和特点,指导抗生素应用。方法：对我院收治的193例AE-COPD患者行痰液细菌培养,药敏采用纸片扩散法。结果：193例AE-COPD患者痰细菌培养,其中158例阳性,共分离出318株致病菌,以革兰阴性杆菌居首位（67.3%）,革兰阳性球菌第2位（20.0%）,真菌第3位（11.6%）。革兰阴性杆菌中以铜绿假单胞菌（32.8%）、卡他莫拉菌（21.2%）和克雷伯杆菌（19.5%）为主要致病菌。革兰阳性球菌中以金黄色葡萄球菌（7.1%）、肺炎链球菌（5.0%）、表皮葡萄球菌（3.7%）为主要致病菌。药敏发现,对铜绿假单胞菌抗菌活性较强的有美罗培南（耐药率3.8%）、头孢哌酮/舒巴坦（耐药率7.8%）和亚胺培南（耐药率7.8%）;卡他莫拉菌：美罗培南和亚胺培南较有效,耐药率分别为4.2%、4.8%。阿米卡星、万古霉素对大部分革兰阳性球菌敏感。结论：AE-COPD下呼吸道致病菌以革兰阴性杆菌为主,且耐药率较高。可根据细菌的分布情况结合本地区常见致病菌类型及耐药流行趋势和药物敏感情况尽早选择敏感抗菌药物。

Distribution and drug resistance of pathogens in acute exacerbation chronic obstructive pulmonary disease

Objective： To analyze the distribution of pathogens in respiratory tract and their drug resistance in the patients with acute exacerbation chronic obstructive pulmonary disease （AE-COPD） for a better use of antibiotics in treatment. Methods： The sputum samples of 193 AE-COPD patients were collected from our hospital and the pathogens species in all samples were tested. The drug sensitivity were determined by K-B paper method. Results： 158 strains of pathogens were found in all sputum samples, of which 67.3% were Gram-negtive, 20, 0% Gram-positive. Among the Gram-negtive baeillis, the main pathogens included Pseudomonas （32.8%） , Moraxelle catarrhalis （21.2%） , Klebsiella Pneumonia （19.5%）. Among the Gram-positive eoccis, the main pathogens included Staphyloccus aureus （7.1%） ,streptococcus pneumoniae （5.0%） ,and Staphylococcus epidermidis （3.7%）. The results of drug sensitivity test showed that Pseudomonas were more sensitive to meropenem and imipenem, Moraxelle catarrhalis also were more sensitive to meropenem and imipenem, and that most of the Gram-positive coceis were more sensitive to amikacin and vancomycin. Conclusions ： Gram-negative bacillus are predominant in lower respiratory tract in AE-COPD patients with higher frequency of drug resistance. Antibiotics collected for AE-COPD must be according to the susceptibility test results.