重庆医学
重慶醫學
중경의학
Chongqing Medicine
2015年
32期
4507-4509
,共3页
肺疾病 ,慢性阻塞性%呼吸道感染%病原菌%耐药性
肺疾病 ,慢性阻塞性%呼吸道感染%病原菌%耐藥性
폐질병 ,만성조새성%호흡도감염%병원균%내약성
pulmonary disease,chronic obstructive%respiratory tract infection%pathogen%drug resistance
目的：了解慢性阻塞性肺疾病急性加重（AECOPD）患者下呼吸道感染病原菌分布及耐药特点。方法选取该院2013～2014年住院的262例AECOPD患者痰液或纤支镜刷取下呼吸道分泌物进行细菌培养鉴定及药敏试验，并进行分析。结果分离出病原菌的患者有215例，分离到病原菌281株，其中革兰阴性杆菌190株（67．6％），革兰阳性球菌76株（27．1％），真菌15株（5．3％）。居前6位病原菌为鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎链球菌。药敏结果显示鲍曼不动杆菌耐药性最强，除左旋氧氟沙星、头孢哌酮／舒巴坦耐药率小于50．0％，其他药物耐药率均大于或等于75．0％。肺炎克雷伯菌和大肠埃希菌对氨苄西林、氨苄西林／舒巴坦、头孢唑林、头孢曲松、头孢替坦、环丙沙星、左旋氧氟沙星、庆大霉素和复方新诺明耐药率均大于或等于70．0％。金黄色葡萄球菌对青霉素G、苯唑西林、红霉素、克林霉素全部耐药（100％）。肺炎链球菌对红霉素、克林霉素、四环素和复方新诺明耐药率均大于或等于75．0％。结论 A P‐COPD患者下呼吸道感染病原菌以革兰阴性杆菌为主，且耐药性严重，临床选用抗菌药物治疗时应重视细菌培养和药敏试验，合理选用抗菌药物。
目的：瞭解慢性阻塞性肺疾病急性加重（AECOPD）患者下呼吸道感染病原菌分佈及耐藥特點。方法選取該院2013～2014年住院的262例AECOPD患者痰液或纖支鏡刷取下呼吸道分泌物進行細菌培養鑒定及藥敏試驗，併進行分析。結果分離齣病原菌的患者有215例，分離到病原菌281株，其中革蘭陰性桿菌190株（67．6％），革蘭暘性毬菌76株（27．1％），真菌15株（5．3％）。居前6位病原菌為鮑曼不動桿菌、大腸埃希菌、肺炎剋雷伯菌、銅綠假單胞菌、金黃色葡萄毬菌和肺炎鏈毬菌。藥敏結果顯示鮑曼不動桿菌耐藥性最彊，除左鏇氧氟沙星、頭孢哌酮／舒巴坦耐藥率小于50．0％，其他藥物耐藥率均大于或等于75．0％。肺炎剋雷伯菌和大腸埃希菌對氨芐西林、氨芐西林／舒巴坦、頭孢唑林、頭孢麯鬆、頭孢替坦、環丙沙星、左鏇氧氟沙星、慶大黴素和複方新諾明耐藥率均大于或等于70．0％。金黃色葡萄毬菌對青黴素G、苯唑西林、紅黴素、剋林黴素全部耐藥（100％）。肺炎鏈毬菌對紅黴素、剋林黴素、四環素和複方新諾明耐藥率均大于或等于75．0％。結論 A P‐COPD患者下呼吸道感染病原菌以革蘭陰性桿菌為主，且耐藥性嚴重，臨床選用抗菌藥物治療時應重視細菌培養和藥敏試驗，閤理選用抗菌藥物。
목적：료해만성조새성폐질병급성가중（AECOPD）환자하호흡도감염병원균분포급내약특점。방법선취해원2013～2014년주원적262례AECOPD환자담액혹섬지경쇄취하호흡도분비물진행세균배양감정급약민시험，병진행분석。결과분리출병원균적환자유215례，분리도병원균281주，기중혁란음성간균190주（67．6％），혁란양성구균76주（27．1％），진균15주（5．3％）。거전6위병원균위포만불동간균、대장애희균、폐염극뢰백균、동록가단포균、금황색포도구균화폐염련구균。약민결과현시포만불동간균내약성최강，제좌선양불사성、두포고동／서파탄내약솔소우50．0％，기타약물내약솔균대우혹등우75．0％。폐염극뢰백균화대장애희균대안변서림、안변서림／서파탄、두포서림、두포곡송、두포체탄、배병사성、좌선양불사성、경대매소화복방신낙명내약솔균대우혹등우70．0％。금황색포도구균대청매소G、분서서림、홍매소、극림매소전부내약（100％）。폐염련구균대홍매소、극림매소、사배소화복방신낙명내약솔균대우혹등우75．0％。결론 A P‐COPD환자하호흡도감염병원균이혁란음성간균위주，차내약성엄중，림상선용항균약물치료시응중시세균배양화약민시험，합리선용항균약물。
Objective To observe the distribution and drug resistance of pathogens cultured from the sputum of hospitalized patients with lower respiratory infection in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) .Methods To i‐dentify the germiculture and test the drug susceptibility of the sputum or respiratory secretion isolated from the bronchial brush of 262 hospitalized AECOPD patients in People′s Hospital of Jiangxi Province from Janurary 2013 to December 2014 and analyze the results .Results Among all the AECOPD patients ,215 cases with positive sputum culture ,281 sputum pathogens were isolated . Gram‐negative bacilli were found in 190(67 .6% ) .Gram‐positive aureus were detected in 76(27 .1% ) .Fungus pathogens occurred in 15(5 .3% ) .The top six pathogenic bacteria were acinetobacter baumannii ,escherichia coli ,klebsiella pneumonia ,pseudomonas aeruginosa ,staphylococcus aureus ,streptococcus pneumonia .Drug susceptibility results showed that the drug resistance of acineto‐bacter baumannii was the strongest .Except that the drug resistance rate of cefoperazone/sulbactam and levofloxacin were less than 50 .0% ,the others were no less than 75 .0% .The drug resistance rate of escherichia coli and klebsiella pneumoniae to ampicillin , ampicillin sulbactam ,cefazolin ,ceftriaxone ,cefotetan ,gentamycin ,ofloxacin ,ciprofloxacin ,and compound sulfamethoxazole trime‐thoprim were no less than 70 .0% .The drug resistance rate of staphylococcus aureus to penicillin G ,oxacillin ,erythromycin ,clinda‐mycin were 100% .The drug resistance rate of streptococcus pneumoniae to erythromycin ,clindamycin ,tetracycline ,sulfamethox‐azole trimethoprim were greater than 75 .0% .Conclusion Gram‐negative bacilli are the main pathogenic bacterium in the AECOPD patients with lower respiratory infection .The key of treatment is to pay more attention to the bacterial culture and drug sensitive test ,use antibiotics reasonably according to the results of drug sensitive experiment .
