摘要
目的探讨慢性阻塞性肺疾病(COPD)患者呼吸道细菌感染的临床特点,为抗感染治疗提供参考依据。方法回顾性分析2008年3月-2013年1月收治的3 057例COPD患者临床资料,其中672例合并呼吸道细菌感染,从中随机抽取103例病情稳定患者,对其进行痰培养及药敏试验,分析病原菌分布及耐药性,采用法国生物梅里埃公司VITEK-260全自动细菌鉴定仪鉴定菌株,K-B纸片扩散法进行药敏试验。结果 3 057例COPD患者中合并呼吸道细菌感染672例,感染率22.0%;103例COPD合并呼吸道细菌感染患者临床表现为慢性咳嗽97例、咳痰83例、气短66例、胸闷54例,分别占94.17%、80.58%、64.08%、52.43%;痰液中培养出病原菌192株,其中革兰阴性杆菌134株占69.79%,革兰阳性球菌58株占30.21%,革兰阴性杆菌中铜绿假单胞菌检出最多,占50.74%,其次为肺炎克雷伯菌、大肠埃希菌,分别占19.27%、11.49%,革兰阳性球菌中金黄色葡萄球菌检出最多21株,占10.94%;肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌对亚胺培南和美罗培南的耐药率均明显低于其他常用抗菌药物,分别为0、11.1%、0,差异有统计学意义(P<0.05)。结论 COPD患者呼吸道细菌感染以革兰阴性杆菌为主,其中铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌检出较多,治疗过程中对于难治感染可以选用亚胺培南和美罗培南。
OBJECTIVE To explore the characteristics of respiratory tract bacterial infections in patients with chronic obstructive pulmonary disease （COPD） to provide guidance for treatment of the infections. METHODS Totally 3 057 COPD patients, who were treated from Mar 2008 to Jan 2013, were enrolled in the study, including 672 cases of respiratory tract bacterial infections, then the data of the subjects were retrospectively analyzed, totally 103 subjects with stable condition were selected from the 672 patients, the sputum culture and drug susceptibility testing were performed, the distribution and drug resistance of pathogens were analyzed, the identification of strains was conducted with the use of VITEK-260 automatic bacteria identification system of BioM4rieux, France, and the drug susceptibility testing was performed by using K-B disk diffusion method. RESULTS Of totally 3057 cases of COPD, the respiratory tract bacterial infections occurred in 672 cases with the infection rate of 22.0~~. The clinical manifestations of the 103 COPD patients complicated with respiratory tract bacterial infections were the chronic cough （97 cases）, expectoration （83 cases）, shortness of breath （66 cases）, and chest tightness （54 cases）, accounting for 94.17~, 80.58~//oo, 64.08~, and 52.43~, respectively. A total of 192 strains of pathogens were isolated from the sputum specimens, including 134 （69. 79~） strains of gram- negative bacilli and 58 （30.21~） strains of gram-positive cocci; the Pseudomonas aeruginosa （50.74 ~） was the predominant species of gram-negative bacilli, followed by the Klebsiella pneumoniae （19. 27~） and Escherichia coli （11.49~）; the Staphylococcus aureus （21 strains ） was the most common species of gram-positive cocci,accounting for 10. 940/oo. The drug resistance rates of the K. pneumoniae, P. aeruginosa, and E. coli to imipenem and meropenem were significantly lower than those to other commonly used antibiotics, which were 0, 11.1 ~, and 0, respectively, the differences were statistically significant （P~ 0. 05）. CONCLUSION The gram-negative bacilli are dominant among the pathogens causing the respiratory tract bacterial infections in the COPD patients, among which the P. aeruginosa, K. pneurnoniae, and E. coli are the most common species; imipenem and mero- penem can be chosen for the treatment of refractory infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第4期889-891,共3页
Chinese Journal of Nosocomiology
基金
浙江省教育厅基金资助项目(Y200803865)
关键词
慢性阻塞性肺疾病
病原菌
感染
耐药性
Chronic obstructive pulmonary disease~ Pathogen
Infection
Drug resistance
