老年 AECOPD 患者呼吸道菌群分布及耐药性分析

目的：了解反复多次住院的老年慢性阻塞性肺病急性加重期(AECOPD)患者呼吸道细菌的临床分布特点及耐药性情况。方法分析399例住院次数≥2次的老年 AE-COPD 患者痰标本普通培养及药物敏感实验。结果共分离出172菌株,革兰阴性杆菌占86.05%；排前3位的是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌。与2013年比较,2014年鲍曼不动杆菌广泛耐药(XDR)率下降,铜绿假单胞菌和肺炎克雷伯菌 XDR 率上升,但差异无统计学意义。鲍曼不动杆菌对氨苄西林、头孢唑啉和头孢噻肟全部耐药。铜绿假单胞菌对多种药物耐药严重,在2014年对美罗培南耐药性明显增加。2014年肺炎克雷伯菌对多种药物敏感性降低。结论多次住院的 AECOPD 患者呼吸道菌群以革兰阴性杆菌为主,细菌耐药严重；了解常见细菌的分布及耐药情况,有助于药物敏感实验结果前合理指导临床使用抗生素。

Analysis of infection and drug resistance of bacteria in respiratory tract of senile patients with AECOPD

Objective To understand infection and drug resistance of bacteria in respiratory tract of senile inpa-tients with multiple acute exacerbation in chronic obstructive pulmonary disease(COPD). Methods An analysis of the common culture of sputum specimens and drug sensitive experiment in 399 senile inpatients with acute exacer-bation of chronic obstructive pulmonary disease (AECOPD) who were hospitalized more than or equal to two times. Results 172 strains of bacteria were isolated, and gram negative bacilli accounted for 86. 05% and the top three were A. baumanii, P. aeruginosa, K. pneumoniae. Drug sensitive experiment showed that extensively drug-resist-ant (XDR) rate of A. baumanii decreased and XDR rate of P. aeruginosa and K. pneumoniae increased in 2014 compared with that in 2013, but no significant difference was detected. A. baumanii was all resistant to ampicillin, cefazolin and cefotaxime. P. aeruginosa was seriously resistant to more than one drug, and the resistance to mero-pene increased significantly in 2014. The sensitivity of K. pneumoniae to more than one drug decreased markedly in 2014. Conclusion Gram negative bacilli are the main bacteria in respiratory tract of senile patients with AECO-PD, hospitalized more than or equal to two times, and antibiotic resistance is serious. Understanding the distribu-tion and drug resistance of common bacteria may be helpful to guide the rational use of antibiotics before the drug sensitivity test.