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目的探讨慢性阻塞性肺疾病(COPD)患者革兰阴性菌肺部感染及耐药性,为临床治疗提供依据。方法选择2010年1月-2014年6月医院收治的1 616例COPD发生肺部感染患者为研究对象,采集患者标本进行病原菌培养鉴定,药敏试验采用纸片扩散(K-B)法,统计细菌培养结果及病原菌耐药性。结果 1 616例COPD并发肺部感染患者的痰标本共检出革兰阴性菌1 288株,检出率为79.7%;革兰阴性菌中以肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌为主,分别占34.4%、18.1%、12.1%;革兰阴性菌对头孢唑林、氨苄西林、磺胺甲噁唑/甲氧苄啶、氨苄西林/舒巴坦、头孢曲松等抗菌药物耐药率较高,对亚胺培南、左氧氟沙星、阿米卡星、他唑巴坦等抗菌药物耐药率较低。结论 COPD感染病原菌以革兰阴性菌多见,其中肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌感染占革兰阴性杆菌感染的前3位;COPD患者革兰阴性菌感染耐药比较严重,临床应加强耐药菌群的监测,合理使用抗菌药物,以提高COPD治疗的效果。
Objective To investigate the pulmonary infection and drug resistance of Gram-negative bacteria in patients with chronic obstructive pulmonary disease (COPD) and provide the basis for clinical treatment. Methods From January 2010 to June 2014, 1 616 COPD patients with pulmonary infection were selected as the research objects. Specimens of patients were collected and identified for pathogen culture. Susceptibility testing using KB method and statistical bacterial culture Results and pathogen resistance. Results A total of 1 288 Gram-negative bacteria were detected in sputum samples of 616 COPD patients with pulmonary infection, the detection rate was 79.7%. Among the gram-negative bacteria, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter mainly accounted for 34.4%, 18.1% and 12.1% respectively. Gram-negative bacteria were resistant to cefazolin, ampicillin, sulfamethoxazole / trimethoprim, ampicillin / sulbactam, Antibiotics such as drug resistance rate is higher, to imipenem, levofloxacin, amikacin, tazobactam and other antimicrobial resistance rate is low. CONCLUSIONS: Gram-negative bacteria are the most common pathogens in COPD. Among them, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii are the top three infections with Gram-negative bacilli. COPD patients with Gram- Drugs more serious clinical should strengthen the monitoring of drug-resistant flora, rational use of antimicrobial agents to improve the effectiveness of COPD treatment.