支气管扩张急性加重期细菌谱及药敏谱调查

目的:了解支气管扩张患者急性加重期细菌谱及药敏谱情况,以指导临床合理使用抗菌药物治疗此类患者.方法:回顾性分析2009年1月至201 1年12月我院收治的支气管扩张急性加重患者146例人院时痰标本的细菌培养及药敏试验结果.结果:146例患者中分离到致病菌54例(37.0％)；分离出无重复细菌56株,其中铜绿假单胞菌45株(80.4％),肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌、嗜麦芽窄食假单胞菌各2株,洋葱伯克霍尔德菌、流感嗜血杆菌、咽峡炎链球菌各1株.铜绿假单胞菌对常用的广谱β内酰胺类、庆大霉素、阿米卡星、环丙沙星的敏感率为71.1％～93.3％.结论:铜绿假单胞菌为引起支气管扩张急性加重的主要致病菌,初始经验性治疗可选择具有抗铜绿假单胞菌活性的广谱3内酰胺类、氨基糖苷类或氟喹诺酮类,并根据临床疗效和痰培养与药敏结果决定是否更改初始治疗药物.

Investigation of Bacterial Distribution and Antimicrobial Resistance in Acute Exacerbation of Bronchiectasis

Objective： To investigate the bacterial distribution and antimicrobial resistance in patients with acute exacerbation of bronchiectasis, for guiding the rational use of antimicrobial agents in these patients in clinic. Methods： Sputum bacterial culture and antimicrobial susceptibility tests from 146 patients with acute exacerbation of bronchiectasis in our hospital from Jan 2009 to Dec 2011 were analyzed retrospectively. Results： From these 146 patients, bacteria were detected in 54 cases, and the positive rate was 37.0%. A total of 56 non-repetitive strains were isolated, 45 strains were Pseudomonas aeruginosa, accounting for 80.4% of all isolates. There were 2 strains of Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Stenotrophomonas maltophilia, and 1 strain of Burkholderia cepacia, Haemophilus influenzae, angina Streptococcus respectively. The sensitivity rate of Pseudomonas aeruginosa to broad-spectrum β-1actams used commonly, gentamicin, amikacin, ciprofloxacin was 71.1%-93.3%. Conclusions：Psendomonas aeruginosa is the major pathogen in patients with acute exacerbation of bronchiectasis. Broad-spectrum β-1actams, aminoglycosides, or fluoroquinolones are available for the initial empirical treatment in these patients, whether to change the initial treatment or not should be decided according to the clinical efficacy, sputum bacterial culture and antimicrobial susceptibility tests.