慢性阻塞性肺疾病急性加重患者痰病原菌分布及耐药性分析

目的 分析本院慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者痰菌分布及耐药特点，更好的指导早期临床用药。方法 采集2014年8月到2016年7月本院呼吸病房的613例行痰培养的AECOPD患者的临床资料及痰培养结果，分析其痰菌分布及耐药特点。结果 送检痰标本共检出病菌406株，其中革兰阴性菌、真菌、革兰阳性菌各247株（60.8%）、103株（25.4%）、56株（13.8%），常见的病菌包括铜绿假单胞菌（17.0%）、白假丝酵母菌（12.8%）、金黄色葡萄球菌（9.9%）、鲍氏/溶血不动杆菌（8.1%）、肺炎克雷伯菌（7.9%）、大肠埃希氏菌（6.9%）、嗜麦芽窄食单胞菌（6.9%）。大肠埃希菌及肺炎克雷伯杆菌产超广谱β-内酰胺酶（ESBLs）阳性率分别为71.4%和34.4%，二者对大部分抗生素有不同程度耐药，铜绿假单胞菌、鲍氏/溶血不动杆菌、嗜麦芽窄食单胞菌耐药率均较高。结论 革兰阴性杆菌为AECOPD患者痰培养的主要菌群，总体耐药性高，结合当地病菌分布及耐药特点选用抗菌药物尤为重要。

Analysis of Distribution and Drug Resistance of Pathogens in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective To analyze the distribution and drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), so as to guide the early clinical drug use better. Methods The clinical data of pathogens of 613 AECOPD patients who had received sputum culture examinations in the Department of Respiratory of our hospital from August 2014 to July 2016 were selected, and their distribution and drug resistance were analyzed. Results Totally, 406 strains of pathogenic bacteria were obtained, among which gram-negative bacteria, fungi, gram-positive bacteria were 247 (60.8%), 103 (25.4%) and 56 (13.8%) strains. The most common bacteria were Pseudomonas aeruginosa (17.0%), Candida albicans (12.8%), Staphylococcus aureus (9.9%), Acinetobacter baumannii/hemolytic (8.1%), Klebsiella pneumonia (7.9%), Escherichia coli (6.9%), Stenotrophomonas maltophilia (6.9%). The ratio of producing extended spectrum beta-lactamases (ESBLs) of Escherichia coli and Klebsiella pneumonia were 71.4% and 34.4%, respectively, and both of them had different resistance to many kinds of antibiotics. Pseudomonas aeruginosa, Acinetobacter baumannii/hemolytic, Stenotrophomonas maltophilia showed high resistance to many kinds of antibiotics. Conclusion Gram-negative bacteria was the main pathogenic bacteria for infection in AECOPD patients with high frequency of drug resistance, considering the local distribution and drug resistance of pathogens to select antibiotic was particularly important.