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Received:May 29, 2019 Published Online:March 20, 2020
Received:May 29, 2019 Published Online:March 20, 2020
中文摘要: 目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道分泌物细菌培养情况及其耐药性。方法 选取2015年11月至2018年11月收治的AECOPD患者221例,采集呼吸道分泌物进行细菌培养及耐药性分析。统计分析主要菌群(革兰阳性球菌、革兰阴性杆菌、真菌)分布情况,并分析主要革兰阳性球菌及革兰阴性菌耐药情况。结果 (1)细菌培养:本组AECOPD患者221例共培养出289株病原菌,其中革兰阴性杆菌195株、占67.47%(195/289),革兰阳性球菌共78株、占26.99%(78/289),真菌16株、占5.54%(16/289)。(2)主要革兰阳性球菌耐药性:金黄色葡萄球菌对红霉素、苯唑西林、青霉素G、克林霉素耐药率均为100.00%,而对万古霉素、奎奴普丁/达福普丁、替加环素耐药率均为0;肺炎链球菌对复方新诺明、四环素、克林霉素、红霉素耐药率较高,均在75.00%以上,而对万古霉素耐药率为0。(3)主要革兰阴性菌耐药性:鲍曼不动杆菌对复方新诺明、环丙沙星、妥布霉素、庆大霉素等耐药率均在80.00%以上,对左旋氧氟沙星、头孢哌酮/舒巴坦耐药率均在50.00%以下;大肠埃希菌对复方新诺明、环丙沙星、头孢唑啉等耐药率均在80.00%以上,对妥布霉素、氨曲南、头孢吡肟等耐药率均在50.00%以下，而对阿米卡星、美罗培南、亚胺培南耐药率均为0;肺炎克雷伯菌对环丙沙星、氨苄西林耐药率均在80.00%以上,对妥布霉素、美罗培南、亚胺培南等耐药率均在50.00%以下,对阿米卡星耐药率为0;铜绿假单胞菌对抗生素药物耐药率均较低,均在15.00%以下。结论 AECOPD致病菌主要为革兰阴性杆菌及革兰阳性球菌,包括金黄色葡萄球菌、肺炎链球菌、鲍曼不动杆菌及大肠埃希菌等,且对抗菌药物耐药性较高,临床可根据呼吸道分泌物细菌培养和药敏试验结果调整抗菌药物治疗方案,以保证治疗的有效性及安全性。
Abstract:Objective To investigate the bacterial distribution and drug resistance of respiratory secretions in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 221 patients with AECOPD from November 2015 to November 2018 were enrolled, in whom respiratory secretions were collected for bacterial culture and drug resistance analysis. The statistical analysis was made of the distribution of the main flora (Gram-positive cocci, Gram-negative bacilli, fungi) and their drug resistance. Results Out of 289 strains of pathogenic bacteria cultured in 221 patients, there were 195 (67.47%) Gram-negative bacilli, 78 (26.99%) Gram-positive cocci, 16 (5.54%) fungi. The resistance rates of Staphylococcus aureus to erythromycin, oxacillin, penicillin G and clindamycin were 100. 00%, while to vancomycin, quinupristin/dalfopristin and tegacyclin was 0. The resistance rates of Streptococcus pneumoniae to compound sulfamethoxazole, tetracycline, clindamycin and erythromycin were over 75%，while to vancomycin was 0. The resistance rates of acinetobacter baumannii to compound sulfamethoxazole, ciprofloxacin, tobramycin and gentamicin were more than 80. 00%, and to levofloxacin and cefoperazone/sulbactam were less than 50. 00%. The resistance rates of Escherichia coli to compound sulfamethoxazole, ciprofloxacin and cefazolin were more than 80. 00%, to tobramycin, aztreonam and cefepime were less than 50. 00%, but to amikacin, meropenem and imipenem were 0. The resistance rates of Klebsiella pneumoniae to ciprofloxacin and ampicillin were above 80. 00%, and to tobramycin, meropenem, and imipenem were all below 50. 00%, but to amikacin was 0. The drug resistance rates of Pseudomonas aeruginosa to antibiotics were all below 15. 00%. Conclusion The pathogens in AECOPD are mainly Gram-negative bacilli and Gram-positive cocci (including Staphylococcus aureus, Streptococcus pneumoniae, Acinetobacter baumannii and Escherichia coli), and they are highly resistant to antibiotics. In clinical practice, the antibiotic treatment can be adjusted according to the results of bacterial culture and drug sensitivity test of respiratory secretion.
keywords: Respiratory secretions Bacterial culture Drug resistance Acute exacerbation of chronic obstructive pulmonary disease Antibacterial drugs Gram-positive cocci Gram-negative bacilli
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基金项目:山东省医药卫生科技发展计划项目(2016WSB24511)
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