老年肺纤维化合并肺气肿患者急性加重期病原学调查

Pathogens in elderly patients with acute exacerbation of combined pulmonary fibrosis emphysema

摘要:

目的 了解老年肺纤维化合并肺气肿（CPFE）患者急性加重时下呼吸道病原体分布及其耐药谱。方法 入选2013年1月至2014年1月因急性加重在重庆医科大学附属第二医院和重庆市中山医院呼吸科住院的CPFE患者76例，分析痰培养与药敏试验结果。结果 76例老年住院患者中，痰培养出88株病原体的患者68例，以革兰阴性菌及真菌为主，检出率位于前6位的病原体分别为鲍氏不动杆菌24株（27.3%）、白假丝酵母18株（20.5%）、肺炎克雷伯菌10株（11.4%）、铜绿假单胞菌8株（9.1%）、嗜麦芽寡养单胞菌6株（6.8%）、阴沟肠杆菌6株（6.8%）。合并两种以上病原体感染的患者26例，对测试抗感染药物存在多药耐药。结论 老年CPFE患者急性加重时，机会感染率高且耐药严重，应区分病因、予以合理的抗感染及糖皮质激素等治疗。

Abstract:

Objective To investigate the distribution and resistance of pathogens isolated from the lower respiratory tract of the elderly patients with acute exacerbation of combined pulmonary fibrosis and emphysema (CPFE). Methods Clinical data of 76 elderly patients with acute exacerbation of CPFE hospitalized in the Department of Respiratory and Critical Care Medicine of the Second Hospital Affiliated to Chongqing Medical University and the Respiratory Center of Chongqing Zhongshan Hospital from January 2013 to January 2014 were collected and analyzed in the study. The results of bacterial culture and antimicrobial susceptibility testing were analyzed. Results There were totally 88 strains of pathogens collected from the 76 cases, which were mainly Gram-negative bacteria and fungi. The top 6 pathogens were Acinetobacter baumannii (24 strains, 27.3%), Candida albicans (18 strains, 20.5%), Klebsiella pneumoniae (10 strains, 11.4%), Pseudomonas aeruginosa (8 strains, 9.1%), Stenotrophomonas maltophilia (6 strains, 6.8%), and Enterobacter cloacae (6 strains, 6.8%). There were 26 cases identified with mixed infection. Most of the obtained pathogens were multiple drug resistant to testing antibiotics. Conclusion For the elderly patients with acute exacerbation of CPFE, they are more prone to getting infections. So, we should distinguish the pathogens, and then give rational use of antibiotics and even glucocorticoid treatment if necessary.