CAJ | 학술논문

目的：了解本院慢性支气管炎合并下呼吸道感染患者致病菌的分布及耐药情况，为临床合理使用抗菌药物提供参考。方法对本院2007年9月6日至2012年3月31日呼吸内科收治的1123例慢性支气管炎合并下呼吸道感染患者的痰细菌培养和药物敏感试验结果进行分析。结果1123例患者痰细菌培养分离出387株致病菌，其中革兰阴性杆菌220株(56.8%)，革兰阳性球菌158株(40.8%)，真菌9株(2.3%)。革兰阴性杆菌中大肠埃希氏菌51株(23.2%)，铜绿假单胞菌43株(19.5%)，肺炎克雷白杆菌39株(17.7%)，肠杆菌21株(9.5%)，不动杆菌17株(7.7%)，卡他莫拉菌10株(4.5%)，阴沟杆菌9株(4.1%)，嗜麦芽窄食单胞菌7株(3.2%)。革兰阳性球菌中肺炎链球菌66株(41.8%)，表皮葡萄球菌48株(30.4%)，金黄色葡萄球菌35株(22.2%)。药敏结果显示，对大肠埃希氏菌敏感性较高的有亚胺培南、头孢哌酮-舒巴坦、头孢吡肟、氨曲南，对铜绿假单胞菌敏感性较高的有头孢他啶、头孢哌酮-舒巴坦、氨曲南、阿米卡星、头孢吡肟、亚胺培南，对嗜麦芽窄食假单胞菌敏感性较高的有环丙沙星、头孢哌酮-舒巴坦，对不动杆菌敏感性较高的有亚胺培南、美罗培南、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦。对革兰阳性球菌敏感性较高的有哌拉西林他唑巴坦、万古霉素、利福霉素、亚胺培南。结论慢性支气管炎合并下呼吸道感染患者致病菌以革兰阴性杆菌和革兰阳性球菌为主，对常用抗菌药物有较高的耐药性，抗菌药物的选用应根据痰细菌培养和药物敏感试验的结果选用，防止细菌对抗菌药物的耐药性不断扩大。
목적：료해본원만성지기관염합병하호흡도감염환자치병균적분포급내약정황，위림상합리사용항균약물제공삼고。방법대본원2007년9월6일지2012년3월31일호흡내과수치적1123례만성지기관염합병하호흡도감염환자적담세균배양화약물민감시험결과진행분석。결과1123례환자담세균배양분리출387주치병균，기중혁란음성간균220주(56.8%)，혁란양성구균158주(40.8%)，진균9주(2.3%)。혁란음성간균중대장애희씨균51주(23.2%)，동록가단포균43주(19.5%)，폐염극뢰백간균39주(17.7%)，장간균21주(9.5%)，불동간균17주(7.7%)，잡타막랍균10주(4.5%)，음구간균9주(4.1%)，기맥아착식단포균7주(3.2%)。혁란양성구균중폐염련구균66주(41.8%)，표피포도구균48주(30.4%)，금황색포도구균35주(22.2%)。약민결과현시，대대장애희씨균민감성교고적유아알배남、두포고동-서파탄、두포필우、안곡남，대동록가단포균민감성교고적유두포타정、두포고동-서파탄、안곡남、아미잡성、두포필우、아알배남，대기맥아착식가단포균민감성교고적유배병사성、두포고동-서파탄，대불동간균민감성교고적유아알배남、미라배남、고랍서림-타서파탄、두포고동-서파탄。대혁란양성구균민감성교고적유고랍서림타서파탄、만고매소、리복매소、아알배남。결론만성지기관염합병하호흡도감염환자치병균이혁란음성간균화혁란양성구균위주，대상용항균약물유교고적내약성，항균약물적선용응근거담세균배양화약물민감시험적결과선용，방지세균대항균약물적내약성불단확대。
Objective To examine pathogens and drug resistance in the patients of chronic bronchitis with lower respiratory tract infections, and to provide a sound basis for using antibiotics. Methods A total of 1123 cases of chronic bronchitis with lower respiratory tract infections were included in the study from June 6 , 2007 to March 31 , 2010. All cases were supplied by department of respiratory medicine in Beijiao Hospital. Bacterial culture and drug sensi-tivity test were performed in the sputum of 1123 cases and the results were analyzed. Results Totaled of 387 pathogens had been isolated from sputum bacterial culture in 1123 cases. The results of experiment showed that 220 Gram-negative bacilli, accounting for 56. 8%, 158 Gram-positive cocci, accounting for 56. 8%, 9 fungi, accounting for 2. 3%, and among the Gram-negative bacilli, 51 Escherichia coli, accounting for 23. 2%, 43 Pseudomonas aeruginosa, accounting for 19. 5%, 39 Klebsiella pneumoniae, accounting for 17. 7%, 21 Bowman Acinetobacter, accounting for 9. 5%, 17 Enterobacter, accounting for 7. 7%, 10 card Mora bacteria, accounting for 4. 5%, 9 Enterobacter cloacae, accounting for 4. 1%, 7 XM Aeromonas, accounting for 3. 2%, among the Gram-positive cocci, 66 Streptococcus pneumoniae, accounting for 41. 8%, 48 Staphylococcus epidermidis, accounting for 30. 4%, 35 Staphylococcus aureus, accounting for 22. 2%. Drug sensitivity test showed that the high sensitivity of antibiotics to E. coli were imipenem, cefoperazone -sulbactam, cefepime and aztreonam, to Pseudomonas aerugino were saceftazidime, cefoperazone - sulbactam, aztreo-nam, amikacin, cefepime, imipenem and Stenotrophomonas, to XM Aeromonas were ciprofloxacin and cefoperazone -sulbactam, to Bowman Acinetobacter were Imipenem, meropenem, piperacillin-tazobactam and cefoperazone-sulbac-tam, to Gram-positive cocci were piperacillin - tazobactam, vancomycin, rifamycin and imipenem. Conclusions Gram-negative bacilli and Gram-positive cocci are the major pathogens in the patients of chronic bronchitis with lower respiratory tract infections. The pathogens have a higher resistance to commonly used antibiotics. Antibiotics selection should be based on sputum bacterial culture and drug sensitivity test.