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目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者肺功能下降对感染病原菌耐药的影响。方法对2010年1月至2013年12月收治的AECOPD患者167例,均进行痰培养和细菌耐药试验。检测患者肺功能,根据肺功能下降程度不同分为FEV1%≥50%组和FEV1%<50%组,比较两组患者的痰培养细菌分布和细菌耐药情况。结果 167例AECOPD患者共进行痰培养237例次,痰培养阳性患者104例(阳性菌株104株),阳性率为62.3%(104/167)。其中革兰阴性菌(G-)75株,革兰阳性菌(G+)26株,真菌3株。除真菌3株外,FEV1%<50%组78例患者病原菌检出70株(89.7%),FEV1%≥50%组89例患者检出31株(34.8%),前者检出率明显高于后者(P<0.01)。菌种分布两组均以G-菌为主,与FEV1%≥50%组比较,FEV1%<50%组Gˉ菌总检出率明显增高(67.9%vs 24.7%,P<0.01),其中肺炎克雷伯杆菌(20.5%vs 7.9%)、大肠埃希菌(14.1%vs 4.5%)和鲍曼不动杆菌检出率(11.5%vs 3.4%)也分别增高,差异亦有统计学意义(P均<0.05)。G+菌总检出率FEV1%<50%组明显高于FEV1%≥50%组(P<0.01),但其中各菌种组间比较差异无统计学意义(P均﹥0.05)。AECOPD患者感染病原菌对普通β-内酰胺类和头孢菌素类抗菌药耐药率较高,对加入竞争性β-内酰胺酶抑制剂的抗菌药耐药率降低,碳青霉素类和万古霉素族糖肽类仍是对多药耐药菌感染的主要治疗用抗菌药。结论 AECOPD患者的肺功能下降对痰培养结果和细菌耐药均有影响,应合理选择抗菌药物。
Objective To investigate the effect of pulmonary function decline on drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods 167 patients with AECOPD admitted from January 2010 to December 2013 were tested for sputum culture and bacterial resistance. The lung function of patients was examined. According to the degree of pulmonary function decline, they were divided into FEV1% ≥50% group and FEV1% <50% group. Bacterial distribution and bacterial resistance in sputum culture were compared between the two groups. Results A total of 167 AECOPD patients performed 237 sputum cultures and 104 sputum cultures (104 positive), with a positive rate of 62.3% (104/167). Among them, 75 Gram-negative bacteria (G-), 26 Gram-positive bacteria (G +) and 3 strains of fungi. Except for 3 fungi, 70 (89.7%) were detected in 78 patients with FEV1% <50% and 31 (34.8%) in 89 patients with FEV1% ≥50%. The detection rate of the former was significantly higher than that of the other The latter (P <0.01). The distribution of bacteria was mainly G- bacteria in both groups. Compared with FEV1% ≥50%, the total detection rate of G- bacteria in FEV1% <50% group was significantly higher (67.9% vs 24.7%, P <0.01) Klebsiella pneumoniae (20.5% vs 7.9%), Escherichia coli (14.1% vs 4.5%) and Acinetobacter baumannii (11.5% vs 3.4%) also increased respectively, with statistical significance ( P <0.05). The total detection rate of G + bacteria in FEV1% <50% group was significantly higher than that in FEV1% ≥50% (P <0.01), but there was no significant difference among them (P> 0.05). AECOPD patients with pathogenic bacteria on the common β-lactams and cephalosporins antibacterial drug resistance rate was higher, adding competitive β-lactamase inhibitor antibacterial drug resistance decreased, carbapenems and vancomycin Family glycopeptides are still the main therapeutic antibacterials for multidrug-resistant bacterial infections. Conclusion AECOPD patients with lung function decline sputum culture results and bacterial resistance are affected, should be a reasonable choice of antimicrobial agents.