慢性阻塞性肺疾病急性加重期患者病原学及耐药分析

[摘要] 目的 探讨慢性阻塞性肺疾病（COPD）急性加重期患者病原学及其耐药性特点。 方法 将我院收治的COPD急性加重期患者128例进行肺功能测定、痰细菌培养、细菌药物敏感试验，根据肺功能将患者分为Ⅰ组（FEV1≥50%预测值）、Ⅱ组（30%预测值＜FEV1＜50%预测值）、Ⅲ组（FEV1≤30%预测值），分析不同肺功能患者病原学特点和细菌耐药性。 结果 128例患者中痰菌定量培养阳性患者96例，阳性率为75.0%，共培养阳性菌105株，其中，革兰阴性菌：铜绿假单胞菌28株（26.7%），大肠埃希菌24株（22.9%），鲍氏不动杆菌15株（14.3%）；革兰阳性菌：金黄色葡萄球菌11株（10.5%），表皮葡萄球菌5株（4.8%），肺炎链球菌5株（4.8%）；另外白假丝酵母菌7株（6.7%）。部分致病菌呈多重耐药。Ⅰ组患者以痰培养阴性为主，Ⅲ组患者以革兰阳性菌、不动杆菌、大肠埃希菌及铜绿假单胞菌为主，各组患者病原学分布差异有统计学意义（P < 0.05）。 结论 慢性阻塞性肺疾病急性加重期患者细菌感染种类与患者肺功能有一定关系，患者肺功能越差，耐药菌分离率越高，对该类患者应进行细菌培养和药敏试验，应用敏感抗生素治疗。

[关键词] 慢性阻塞性肺疾病；急性加重期；病原学；耐药分析

[中图分类号] R378 [文献标识码] A [文章编号] 1673-7210（2012）08（c）-0099-03

Etiology and drug resistance analysis of patients with chronic obstructive pulmonary disease of acute exacerbation stage

MA Zhengquan

Department of Respiratory Medicine, the Ninth Hospital of Xi'an City, Shannxi Province, Xi'an 710052, China

[Abstract] Objective To explore characteristics of etiology and drug resistance in patients with chronic obstructive pulmonary disease (COPD) of acute exacerbation stage. Methods 128 admitted patients with COPD of acute exacerbation stage, according to their pulmonary function, were divided into three groups: group Ⅰwith forced expiratory volume in the first second (FEV1) no less than 50% of predictive value, group Ⅱ with FEV1 between 30% to 50% of predictive values, and group Ⅲ with FEV1 no more than 30% of predictive value. Characteristics of etiology and drug resistance in varied pulmonary function participants were analyzed. Results There were 96 patients out of 128 cases with positive result of bacterium quantitative culture in sputum, and the positive rate was 75.0%. Among cultured 105 strains of positive bacteria, gram negative bacteria: numbers of pseudomonas aeruginosa, escherichia coli and acinetobacter baumannii were 28 strains (26.7%), 24 strains (22.9%) and 15 strains (14.3%) respectively; gram positive bacteria: numbers of staphylococcus aureus, staphylococcus epidermidis and streptococcus pneumonia were in turn 11 strains (10.5%), 5 strains (4.8%) and 5 strains (4.8%); candida albicans was 7 strains (6.7%). Part of pathogenic bacteria demonstrated a multi-drug resistance. Outcome of sputum culture in group Ⅰwas mostly negative, while predominant bacteria in group Ⅲ were gram positive bacteria, acinetobacter, escherichia coli and pseudomonadaceae. Etiological distributions in three groups displayed significant differences (P < 0.05). Conclusion Bacterial species contracted by COPD patients of acute exacerbation stage have a certain relationship with their pulmonary function. The worse pulmonary function is, the higher possibility drug resistance bacterium is isolated. For such patients, clinical doctors should select sensitive antibiotics to treat after bacterium culture and drug resistance test.