慢性阻塞性肺疾病患者急性发作期的病原菌分布和耐药性分析

目的了解慢性阻塞性肺疾病(COPD)急性发作期的感染的病原菌分布和耐药特点,合理选择抗菌药物,及时、更好地控制病情。方法选择2009年10月1日—2011年9月30日铜陵市人民医院干部科、呼吸科收治的所有慢性阻塞性肺疾病急性加重期痰培养阳性185例患者219份痰标本,用API系统做细菌鉴定,药敏试验采用Kirby-Baure法,ESBLs表型筛选和确认试验按照NCCLS 2003年版执行。结果共分离出各类致病菌219株,其中革兰阳性球菌22株(10.0%),革兰阴性杆菌187株(85.4%),真菌10株(4.6%)。甲氧西林耐药的金黄色葡萄球菌为16.7%,肺炎克雷伯菌和大肠埃希菌ESBLs检出率为39.3%、96.3%。结论 COPD急性发作期感染的致病菌以革兰阴性杆菌为主,且耐药率较高。临床上应结合该地区常见致病菌分布及耐药流行趋势,正确选择敏感抗菌药物。

Distribution and drug resistance of pathogenic bacteria in patients with acute exacerbation of chronicobstructive pulmonary disease

Objective To investigate the distribution and drug resistance of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease, and to offer the reference for a reasonable choice of antibiotics in treatment so as to control the disease timely and better. Methods Totally 219 sputum samples were collected from 185 sputum culture-positive patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in department of cadres and respiratory of Tongling People＇ s Hospital between Octobar 1,2009 and September 30,2011. The identification of bacteria was carried out by using API system, the anti- biotic susceptibility was performed by Kirby-Baure method, and the screening and confirmatory test of ESBLs phenotype were performed according to NCCLS 2003. Results Altogether 219 pathogenic strains were isolated. Twenty-two strains of them （ 10.0% ） were Grampositive cocci, 187 （85.4%） Gram-negative bacilli, and 10 （4. 6% ） fungi. Methicillin-resistant of staphylococcus aureus accounted for 16.7%. The ESBLs detected rates of klebsiella pneumoniae and escherichia coli were 39.3% and 96.3% , respectively. Conclusion The main pathogens infected in acute exacerbation of COPD are Gram-negative bacteria, and the pathogens show high drug resistance. The rational use of antibiotics in clinical therapy should combine with the distribution of common pathogens and drug resistance trends in the region.