老年慢性阻塞性肺疾病急性加重期患者呼吸道病原菌分布与耐药性

Distribution and drug resistance of respiratory tract pathogens in the elderly with acute exacerbation of chronic obstructive pulmonary disease

摘要:

目的 分析老年慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道病原菌分布及耐药性,以指导临床合理用药。方法 回顾性分析2014年12月至2019年6月徐州医科大学附属医院急诊重症医学科收治的痰培养结果阳性的93例老年AECOPD患者的临床资料,对患者痰标本进行病原菌检测及药敏试验,研究其病原菌分布及耐药性。结果 所有痰培养结果阳性的老年AECOPD患者中,单一感染55例(59.14%),包括细菌感染50例(53.76%)、真菌感染5例(5.38%)；混合感染38 例(40.86%),包括多种细菌混合感染24例(25.81%)、细菌真菌混合感染14例(15.05%)。共检测出病原菌138株,其中,革兰阳性菌15株(10.87%)、革兰阴性菌103株(74.64%)、真菌20株(14.49%)。革兰阳性菌主要为金黄色葡萄球菌等,革兰阴性菌主要为鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌等,真菌主要为白假丝酵母菌、曲霉菌等。革兰阳性菌中金黄色葡萄球菌对青霉素、苯唑西林、克林霉素、红霉素的耐药率均为100%,对替考拉宁、万古霉素、达托霉素、利奈唑胺、奎奴普丁、呋喃妥因的敏感性高,耐药率为0%。革兰阴性菌对头孢唑林、头孢曲松的耐药率均为100%,对头孢他啶、左氧氟沙星、环丙沙星、复方新诺明的耐药率>40%,对替加环素、多粘菌素的敏感性较高。结论 老年AECOPD患者呼吸道病原菌以革兰阴性菌为主,其中鲍曼不动杆菌最多。检出的病原菌中耐药菌较多,临床上应根据细菌培养结果及耐药性分析合理选择抗菌药物。

Abstract:

Objective To analyze the distribution and drug resistance of pathogenic bacteria in respiratory tract of the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in order to guide rational clinical drug use. MethodsThe clinical data of 93 elderly AECOPD patients who had positive sputum culture results admitted in the Department of Emergency Critical Care Medicine of the Affiliated Hospital of Xuzhou Medical University from December 2014 to June 2019 were collected and retrospectively analyzed. The sputum samples of the patients were tested for pathogenic bacteria and drug susceptibility test to study the distribution and drug resistance of pathogenic bacteria. Results Among the elderly AECOPD patients with positive sputum culture results, there were 55 cases (59.14%) of single infection, including 50 cases (53.76%) of bacterial infection and 5 cases (5.38%) of fungal infection; and 38 cases (40.86%) of mixed infection, including 24 cases (25.81%) of mixed infection of multiple bacteria and 14 cases (15.05%) of bacterial and fungal mixed infection. In the 138 detected pathogens, there were 15 strains of Gram-positive bacteria (10.87%), 103 strains of Gram-negative bacteria (74.64%) and 20 strains of fungi (14.49%). Gram-positive bacteria were mainly Staphylococcus aureus. Gram-negative bacteria were mainly Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, etc. And fungi were mainly Candida albicans, Aspergillus, etc. The drug resistance rates of Staphylococcus aureus in Gram-positive bacteria to penicillin, oxacillin, clindamycin and erythromycin were all 100%, and those to teicoplanin, vancomycin, daptomycin, linezolid, quinupristin and nitrofurantoin were 0%. The drug resistance rates of Gram-negative bacteria to cefazolin and ceftriaxone were all 100%, those to ceftazidime, levofloxacin, ciprofloxacin and cotrimoxazole were larger than 40%, and the sensitivity to tigacycline and polymyxin was higher. Conclusion Respiratory pathogens in the elderly AECOPD patients are mainly Gram-negative bacteria, with Acinetobacter baumannii the most common. There are many drug-resistant bacteria in the detected pathogenic bacteria, so antimicrobial drugs should be reasonably selected according to the results of bacterial culture and drug resistance analysis.