慢性阻塞性肺病急性加重期呼吸道病原菌分布及耐药性浅析

作者：王永兴，曹家月，郭梅，谢柏梅，刘德江，刘振霞

【关键词】 ，肺

【Abstract】 AIM: To analyze the distribution of pathogens in respiratory tract and their drug resistance in the patients with acute explosion chronic obstructive pulmonary disease (AECOPD) for a better use of antibiotics in treatment. METHODS: The sputum samples of 240 AECOPD patients from January 2002 to May 2004 were collected from our hospital and the pathogens species in all samples were tested. The drug sensitivity was determined by slip diffusion method. RESULTS: 114 strains of pathogens were found in all sputum samples. 66.7% of them were Gramnegative， 24.6% were Grampositive and 7.0% were epiphytes. Among the Gramnegative bacillis， the main pathogens included Pseudomonas (28.1%)， Haemophilus influenza (15.8%)， enteric bacilli (12.3%)， and Klebsiella pneumoniae (8.8%). Among the Grampositive coccis， the main pathogens included Staphyloccus aureus (12.3%)， Pneumococcus (7.0%) and Staphyloccus epidermindis (5.3%). The results of drug sensitivity test showed that most of the Gramnegative bacillis were more sensitive to ticarcilli/clavulanate potassium， imipenem， ceftazidime， piperacillin and amikacin， and that most of the Grampositive coccis were more sensitive to imipenem， ceftazidime and vancomycin. CONCLUSION: Gramnegative bacillus are predominant in lower respiratory tract in AECOPD patients with higher frequency of drug resistance. The 3rd or 4th generation of cephalosporins and some antibiotics with the capability of inhibiting ESBLS are recommended in clinical application. 【Keywords】 lung diseases， obstructive; acute disease; chronic disease; pathogen， drug resistance， microbial 【摘要】 目的： 总结我院慢性阻塞性肺病急性加重期呼吸道感染病原菌分布和耐药性特点，指导抗生素应用. 方法： 对我院200201/200405呼吸病房及干部病房收治的240例AECOPD患者行痰液细菌培养，药敏采用纸片扩散法. 结果： 240例AECOPD患者痰细菌培养分离出114株致病菌，以革兰阴性杆菌占首位（66.7%），革兰阳性球菌第2位（24.6%），真菌第3位（7.0%）. 革兰阴性杆菌中以假单胞菌属（28.1%）、流感嗜血杆菌（15.8%）、肠杆菌属（12.3%）、肺炎克雷伯杆菌（8.8%）为主要致病菌. 革兰阳性球菌中以金黄色葡萄球菌（12.3%）、肺炎链球菌（7.0%）、表皮葡萄球菌（5.3%）为主要致病菌. 药敏发现，替卡西林/克拉维酸、亚胺培南、头孢他啶、哌拉西林、丁胺卡那对大部分革兰阴性杆菌有较好敏感性，亚胺培南、头孢他啶、万古霉素对大部分革兰阳性球菌有较好敏感性. 结论： AECOPD下呼吸道致病菌以革兰阴性杆菌为主，且耐药率较高. 经验用药宜选头孢3， 4代或含有β内酰胺酶抑制剂的抗生素. 【关键词】 肺疾病，阻塞性；急性病；慢性病；病菌；抗药性，微生物 0引言 慢性阻塞性肺病急性加重期（acute explosion chronic obstructive pulmonary disease， AECOPD）在临床上极为常见，已经成为周围呼吸功能衰竭的主要原因. 其病原菌构成较复杂，且随着抗生素、糖皮质激素的滥用，细菌耐药现象日趋严重，给治疗带来很大困难. 为了解AECOPD下呼吸道感染病原菌分布和耐药性特点，指导抗生素应用，我们对我院呼吸科病房及干部病房AECOPD患者行痰细菌培养及药敏试验，结果分析报道如下. 1对象和方法 1.1对象 我院200201/200405呼吸病房及干部病房收治的AECOPD患者240(男165，女75)例. 年龄51～89（平均62.8）岁，均符合中华呼吸学会1997年制定的COPD诊断标准，且有新近发生的痰量增加、脓性痰增多和呼吸困难加重，符合AECOPD. 其中合并糖尿病38例，合并慢性肾功能不全15例. 以AECOPD入院182例，以其他疾病入院，院内发生AECOPD 58例. 1.2方法 在应用抗生素前或抗生素疗效差时行痰培养. 患者晨起清水及30 mL/L双氧水漱口，用力深咳第1口痰弃去，留第2口痰于无菌瓶中，1 h内接种到羊血平板和巧克力平板，CO2孵箱35℃孵育. 以痰涂片光镜检查每低倍视野鳞状上皮细胞<10个，白细胞>25个，或鳞状上皮细胞/白细胞<1/2.5者为合格标本. 按常规分离培养，遵循《全国临床检验操作规程》. 连续2次培养为同一细菌，即为可靠致病菌. 药敏测定采用国际标准KirbyBaver纸片扩散法，按美国NCCLS标准判定.