2016～2017年湛江市第一中医医院慢性阻塞性肺疾病急性加重期患者呼吸道病原菌分布及耐药性分析

郑黎明 刘华珍 陈湛

[摘要]目的 分析2016年1月～2017年12月湛江市第一中醫医院慢性阻塞性肺疾病急性加重期患者呼吸道病原菌分布及耐药性，为临床合理使用抗菌药物提供指导。方法 通过回顾性分析，对湛江市第一中医医院2016年1月～2017年12月的300例慢性阻塞性肺疾病急性加重期患者的送检呼吸道病原菌检测情况和细菌药敏试验结果进行整理和分析，得出病原菌分布及耐药情况。结果 300例样本中，共检出326株菌株，其中革兰阳性菌126株，占38.66%，革兰阴性菌182株，占55.82%，真菌18株，占5.52%。金黄色葡萄球菌对青霉素、苯唑西林的耐药率高于50%，对万古霉素和替考拉宁不表现出耐药性。表皮葡萄球菌对青霉素、苯唑西林、头孢唑啉、头孢他定、头孢西丁的耐药率高于50%，对庆大霉素、万古霉素、替考拉宁的耐药率较低。铜绿假单胞菌对哌拉西林、丁胺卡那、庆大霉素、环丙沙星、左氧氟沙星的耐药率高于20%，对亚胺培南的耐药率较低。大肠埃希菌对哌拉西林、丁胺卡那、庆大霉素、环丙沙星、左氧氟沙星、亚胺培南的耐药率高于20%。结论 我院2016年1月～2017年12月慢性阻塞性肺疾病急性加重期患者的呼吸道病原菌以革兰阴性菌为主，耐药率较高，应结合药敏试验结果选择合理抗菌药，同时加强耐药性监测，提高临床治疗效果。

[关键词]慢性阻塞性肺疾病；急性加重期；病原菌；耐药性

[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0135-04

Distribution and drug resistance of respiratory pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease in the First Hospital of Traditional Chinese Medicine in Zhanjiang City from 2016 to 2017

ZHENG Li-ming1 LIU Hua-zhen2 CHEN Zhan1

1.Department of Pharmacy，the First Hospital of Traditional Chinese Medicine in Zhanjiang City，Guangdong Province，Zhanjiang 524043，China；2.Department of Pharmacy，Central People′s Hospital in Zhanjiang City，Guangdong Province，Zhanjiang 524037，China

[Abstract]Objective To analyze the distribution and drug resistance of respiratory pathogens bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease in the the First Hospital of Traditional Chinese Medicine in Zhanjiang City from January 2016 to December 2017，so as to provide guidance for rational use of antibiotics in clinic.Methods A total of 300 patients with acute exacerbation of chronic obstructive pulmonary disease from January 2016 to December 2017 in the the First Hospital of Traditional Chinese Medicine in Zhanjiang City were checked and analyzed for respiratory tract pathogen detection and bacterial susceptibility test results，and the distribution and drug resistance of pathogenic bacteria were obtained by retrospective analysis.Results Of the 300 samples，326 strains were detected，of which 126 were Gram-positive bacteria，account for 38.66%，182 strains of Gram-negative bacteria，accounting for 55.82%，18 strains of Fungi，accounting for 5.52%.The resistance rates of Staphylococcus aureus to Penicillin，Oxacillin were higher than 50%，while no drug resistance to Vancomycin and Teicoplanin was demonstrated.The resistance rates of Staphylococcus epidermidis to Penicillin，Oxacillin，Cefazolin，Ceftazidime and Cefoxitin were higher than 50%，however，it showed a low resistance rate for Gentamicin，Vancomycin and Teicoplanin.The resistance rates of Pseudomonas aeruginosa to Piperacillin，Amikacin，Gentamycin，Ciprofloxacin and Levofloxacin were higher than 20%，and the resistance rate to Imipenem were low.The resistance rate of Escherichia coli to Piperacillin，Amikacin，Gentamicin，Ciprofloxacin，Levofloxacin and Imipenem were higher than 20%.Conclusions The pathogenic bacteria of respiratory tract were mainly Gram-negative bacteria in the acute exacerbation period of chronic obstructive pulmonary disease in our hospital from from January 2016 to December 2017.The rate of drug resistance is high.In clinical practice，rational antimicrobial agents should be selected in combination with drug sensitivity test results.Meanwhile，the drug resistance monitoring should be strengthened to improve the clinical therapeutic effect.

[Key words]Chronic obstructive pulmonary disease；Acute exacerbation period；Pathogenic bacteria；Drug resistance

慢性阻塞性肺疾病作为呼吸内科的一种常见病及多发病，以气流不完全受限为主要特征，并呈进行性进展，由于随着病情的发展其可发展为肺心病及呼吸衰竭，因此具有较高的致残率和致死率[1]。……