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目的了解慢性阻塞性肺疾病急性发作期(AECOPD)患者下呼吸道感染的病原菌分布及耐药性特点,以指导临床用药。方法对2007年1月-2008年6月的698例AECOPD患者的临床资料及其下呼吸道感染病原菌构成及药物敏感性结果进行分析。抗生素敏感性测定采用Kribry-Bauer(KB)纸片法,最低抑菌浓度(MIC)测定采用琼脂二倍稀释法。结果698例患者分离出致病菌株839株,培养结果以革兰氏阴性杆菌为主(472株56.26%),其中铜绿假单胞菌、肺炎克雷伯菌为主的致病菌株。真菌占第二位,共338株占40.2%,即白色念珠菌为主,革兰阳性球菌占第三位,共27株占2.74%,主要为金黄色葡萄球菌。同时获得2个以上细菌的123例占26.1%,对革兰氏阴性杆菌耐药率在70%以下的有亚胺培南/西司他丁(0)、头孢哌酮/舒巴坦(耐药率20.3%)、派拉西林/他唑巴坦(耐药率24.3%)。万古霉素对革兰氏阳性球菌的耐药率为0,亚胺培南/西司他丁对金黄色葡萄球菌的耐药率为7.4%。结论AECOPD患者年龄大,多伴有基础疾病,反复应用广谱抗生素及激素;革兰氏阴性杆菌及真菌为其主要致病菌;且耐药率高,对加酶抑制剂的复合型抗生素敏感性高。AECO-PD抗菌药物的选用应根据当地AECOPD常见病原菌种类及对抗药物的敏感性,合理选用,并动态监测药物的耐药性。
Objective To understand the distribution of pathogens and drug resistance of lower respiratory tract infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) to guide the clinical medication. Methods The clinical data of 698 AECOPD patients from January 2007 to June 2008 and the pathogenic bacteria composition and drug susceptibility of lower respiratory tract infection were analyzed. Antibiotic susceptibility was determined using the Kribry-Bauer (KB) disk method and the minimum inhibitory concentration (MIC) assay using a two-fold dilution of agar. Results A total of 839 strains of pathogens were isolated from 698 patients. The results showed that Gram-negative bacilli were the main pathogens (472 strains, 56.26%), including Pseudomonas aeruginosa and Klebsiella pneumoniae. Fungi accounted for the second place, a total of 338 strains accounted for 40.2%, namely, Candida albicans, Gram-positive cocci accounted for third place, a total of 27 strains accounted for 2.74%, mainly Staphylococcus aureus. There were 123 cases with more than 2 bacteria accounting for 26.1%, and those resistant to Gram-negative bacilli were imipenem / cilastatin (0), cefoperazone / sulbactam The rate of drug was 20.3%), and the rate of prasicillin / tazobactam (drug resistance rate was 24.3%). Vancomycin resistance to Gram-positive cocci was 0, imipenem / cilastatin resistance to Staphylococcus aureus was 7.4%. Conclusion AECOPD patients are older and more with underlying diseases, repeated use of broad-spectrum antibiotics and hormones; Gram-negative bacilli and fungi are the main pathogens; and the high rate of resistance, sensitive to compound antibiotics plus enzyme inhibitors High sex. AECO-PD antibacterial drug selection should be based on the local AECOPD common pathogen species and anti-drug sensitivity, rational selection, and dynamic monitoring of drug resistance.