慢性阻塞性肺疾病急性加重期住院患者病原菌分布及耐药分析

目的分析我院呼吸内科慢阻肺急性加重期住院患者痰细菌培养、病原菌分布及耐药情况,为临床医师经验性合理应用抗菌药物提供参考依据。方法回顾性分析我院2013年9月-2015年9月呼吸内科住院1046例AECOPD患者痰细菌培养、药敏及耐药情况。结果 1046例AECOPD患者痰培养分离出病原菌224株,阳性率21.41%。其中,革兰氏阴性菌188株,占83.93%,常见病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性菌3株,占病原菌总分布1.35%,分别为:金黄色葡萄球菌、肺炎链球菌、草绿色链球菌;真菌33株,占14.72%,依次为:白色念珠菌、酵母样真菌、曲霉菌、丝状真菌。结论 AECOPD患者病原菌以革兰氏阴性菌为主;临床上对反复感染及病情严重的住院患者应选用广谱β-内酰胺类、氨基糖苷类、喹诺酮类敏感抗菌药物或联合用药;并高度警惕真菌感染。

Distribution and drug resistance of pathogenic bacteria in patients with AECOPD

Objective To provide evidence of antibiotics in clinical empirical application for clinical physi-cians by retrospectively analyzing the pathogenic bacteria distribution and drug resistance of sputum bacterial culture in patients with AECOPD. Methods The sputum bacterial culture, drug sensitivity and drug resistance of 1046 pa-tients with AECOPD from September 2013 to September 2015 were retrospectively analyzed. Results 224 of the 1046 patients with AECOPD were separated from the sputum bacterial culture, and the positive rate was 21. 41%. A-mong them, gram negative bacteria were 188, accounting for 83. 93%. The common bacteria were Klebsiella pneu-moniae, Pseudomonas aeruginosa, Bauman Acinetobocter and Enterobacter cloacae. There were only 3 gram positive bacterias, accounting for 1. 35%, including Staphylococcus aureus, Streptococcus pneumoniae and green Streptococ-cus, respectively. There were 33 strains of fungi, accounting for 14. 72%. The sequence was Candida albicans, yeast like fungi, Aspergillus and filamentous fungi. Conclusion Pathogenic bacteria in patients with AECOPD are mainly gram negative bacteria. The repeated infection and serious illness patients should be given broad-spectrumβ-amide, amino glycoside, quinolone sensitive antimicrobial drugs or drug combinations, and fungal infections should be paid more attention.