CAJ | 학술논문

目的：探讨不同组别慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的常见病原体,并对其耐药性进行分析,为临床经验性选择抗生素提供指导。方法收集我院2010—2014年收住入院的 AECOPD 患者536例,按照2013年 GOLD指南综合评估分为 A、B、C、D 4组。对536例 AECOPD 患者的痰标本进行细菌培养和药敏检测。结果536例患者中共有311例患者痰标本检出病原菌,检出率为58.02%,共检出病原菌368株,有45例同时检出两株或两株以上的病原菌。其中革兰阳性球菌115株,检出率最高的为金黄色葡萄球菌、肺炎链球菌；革兰阴性杆菌224例,病原菌依次为肺炎克雷伯菌、绿脓杆菌、大肠埃希菌、流感嗜血杆菌；真菌共检出29株。A 组检出率最高的细菌为肺炎链球菌及金黄色葡萄球菌。B 组为流感嗜血杆菌及卡他莫拉菌。C 组为肺炎克雷伯菌、大肠埃希菌。D 组为绿脓杆菌、肺炎克雷伯菌、大肠埃希菌等。药敏结果显示革兰阳性菌对阿奇霉素、复方新诺明、红霉素、阿莫西林克拉维酸、头孢曲松耐药率均较高,未发现对万古霉素及利奈唑胺耐药菌株。碳青霉烯类抗生素耐药肠杆菌科细菌逐年增加,此类细菌往往对临床常用的抗生素呈现耐药。绿脓杆菌对亚胺培南的耐药率高达35.6%。结论不同组别的 AECOPD 患者的致病菌不一样,且目前细菌耐药现状严峻,临床医师使用抗生素时应根据患者的综合评估、细菌耐药性情况,制定合理的抗感染治疗方案。
목적：탐토불동조별만성조새성폐질병급성가중기(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)적상견병원체,병대기내약성진행분석,위림상경험성선택항생소제공지도。방법수집아원2010—2014년수주입원적 AECOPD 환자536례,안조2013년 GOLD지남종합평고분위 A、B、C、D 4조。대536례 AECOPD 환자적담표본진행세균배양화약민검측。결과536례환자중공유311례환자담표본검출병원균,검출솔위58.02%,공검출병원균368주,유45례동시검출량주혹량주이상적병원균。기중혁란양성구균115주,검출솔최고적위금황색포도구균、폐염련구균；혁란음성간균224례,병원균의차위폐염극뢰백균、록농간균、대장애희균、류감기혈간균；진균공검출29주。A 조검출솔최고적세균위폐염련구균급금황색포도구균。B 조위류감기혈간균급잡타막랍균。C 조위폐염극뢰백균、대장애희균。D 조위록농간균、폐염극뢰백균、대장애희균등。약민결과현시혁란양성균대아기매소、복방신낙명、홍매소、아막서림극랍유산、두포곡송내약솔균교고,미발현대만고매소급리내서알내약균주。탄청매희류항생소내약장간균과세균축년증가,차류세균왕왕대림상상용적항생소정현내약。록농간균대아알배남적내약솔고체35.6%。결론불동조별적 AECOPD 환자적치병균불일양,차목전세균내약현상엄준,림상의사사용항생소시응근거환자적종합평고、세균내약성정황,제정합리적항감염치료방안。
Objective To explore pathogens and their drug resistance in different groups of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and provide guidance for clinical empiric antibiotic treatment.Methods Five hundred and thirty-six patients with AECOPD were selected in our hospital from 2010 to 2014.After comprehensive assessment classification according to GOLD (2013 ),all patients were divided into A,B,C and D four groups.Bacterial culture and drug susceptibility testing were performed on sputum specimens of 536 cases of patients.Results Three hundred and sixty-eight pathogens were isolated from 31 1 AECOPD patients of a total of 526 (58.02%), 45 patients were isolated two or more than two pathogens.One hundred and fifteen pathogens were Gram-positive bacteria,most of which were Staphylococcus aureus,Streptococcus pneumoniae.Two hundred and twenty-four Gram-negative bacteria were isolated,and most of which were Klebsiella pneumoniae, Pseudomonas aeruginosa,Escherichia coli,Haemophilus influenzae.Twenty-nine fungi were detected. Streptococcus pneumoniae and Staphylococcus aureus were predominant in group A while Haemophilus influenzae and Moraxella catarrhalis in group B.Klebsiella pneumoniae and Escherichia coli were most frequent,in group D Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli were the most frequent.Susceptibility testing results showed that gram-positive bacteria were highly resistant to azithromycin,high cotrimoxazole,erythromycin,amoxicillin/clavulanic acid,ceftriaxone.No vancomycin and Linezolid resistant strain was found in gram-positive isolates.Carbapenem-resistant Enterobacteriaceae were increased,these bacteria were also resisted to other antibiotics we usually use.Pseudomonas aeruginosa showed a high resistance rate to imipenem of 35.6%.Conclusions Pathogens distribution was different in different groups of acute exacerbation of chronic obstructive pulmonary disease and the resistance of bacteria to antibiotics was serious.We should use antibiotics reasonably according to the comprehensive assessment classification of patients and surveillance of bacterial resistance.