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目的:探讨临夏地区慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病(CCP)急性加重期患者常见G-菌分布及耐药情况,为合理使用抗生素提供临床依据。方法:回顾性对COPD合并CCP急性加重期患者痰培养及药敏实验结果进行分析。结果:培养出致病菌有417株,以G-杆菌为主(279株,占67.9%),G+球菌占第2位(125株,占30%),真菌占第3位(13株,占3.1%)。主要G-病原菌为肺炎克雷伯杆菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌。肺炎克雷伯杆菌、铜绿假单胞菌对青霉素、氨苄西林,头孢唑啉、头孢呋辛、有较高的耐药性,对氨苄西林/舒巴坦钠、哌拉西林/他唑巴坦、头孢吡肟、亚胺培南有较高的敏感性。结论:临夏地区COPD合并CCP患者下呼吸道感染病原菌以G-杆菌为主,对常用抗菌药物耐药性较高,治疗建议根据药敏试验选用抗生素或经验治疗选用第三、四代头孢或含有β内酰胺酶抑制剂的复合抗生素。
Objective: To investigate the distribution and drug resistance of common G-bacteria in chronic obstructive pulmonary disease (COPD) patients with acute exacerbation of chronic cor pulmonale (CCP) in Linxia region and to provide a clinical basis for rational use of antibiotics. Methods: The sputum culture and drug susceptibility test results of patients with acute exacerbation of COPD complicated with COPD were retrospectively analyzed. Results: A total of 417 strains of pathogenic bacteria were cultivated, accounting for 67.9% (279 strains), G + bacteria accounting for 2 (125 strains, accounting for 30%), fungi accounting for 3 (13 strains, Accounting for 3.1%). The main G-pathogen Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli. Klebsiella pneumoniae, Pseudomonas aeruginosa against penicillin, ampicillin, cefazolin, cefuroxime, have a higher resistance to ampicillin / sulbactam sodium, piperacillin / tazobactam , Cefepime, imipenem have higher sensitivity. Conclusion: The main pathogens of lower respiratory tract infection in COPD patients with COPD in Linxia are G-bacilli, which are resistant to commonly used antimicrobial agents. The treatment is recommended according to drug susceptibility test using antibiotics or experience treatment of the third and fourth generation cephalosporins or β Lactamase inhibitor composite antibiotics.