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慢性阻塞性肺疾病机械通气患者病原菌耐药性分析

Resistance analysis of pathogenic bacteria in chronic obstructive pulmonary disease patients with mechanical ventilation

摘要:

目的 调查机械通气的慢性阻塞性肺疾病急性加重(AECOPD)患者主要病原菌的构成和耐药情况,为临床治疗提供依据.方法 2016年1月在至2017年12月在温州医科大学附属第二医院EICU和ICU机械通气的AECOPD患者,收集各种标本进行细茵鉴定和药敏试验;对其临床资料、试验结果进行分析.结果 共纳入104例患者.各种标本中分离出病原菌163株,其中革兰阴性菌最多,占74.8%.耐药性分析显示:革兰阴性菌对第三代头孢菌素耐药严重,对舒普深、碳青霉烯类较敏感;革兰阳性球菌对万古霉素、利奈唑胺敏感.真菌对两性霉素B、5氟胞嘧啶较敏感.大部分细茵呈多重耐药.结论 危重AECOPD患者选用抗生索治疗时应重视细菌培养及药敏试验,减少不合理用药,减少耐药菌株与二重感染产生.

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abstracts:

Objective To investigate the constitution and drug resistance status of the major pathogens in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),so as to provide evidences for clinical treatment.Methods From patients with AECOPD undergoing mechanical ventilation in EICU or ICU of the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2017,various specimens were collected for identification and drug susceptibility testing of pathogens;the clinical data and test results were analyzed.Results A total of 104 patients were included in the study.Total of 163 strains of pathogens were isolated from the specimens,of which gram-negative pathogens were the most common,accounting for 74.8% of any pathogens.Drug resistance analysis showed that gram-negative pathogens were severely resistant to third generation cephalosporins,and were more sensitive to Sulperazon and carbapenems;gram-positive cocci were more sensitive to vancomycin and linezolid.Fungi were more sensitive to amphotericin B and 5-fluorocytosine.Most of the pathogens were multi-resistant.Conclusions In selecting antibiotics for the treatment of critical patients with AECOPD,emphasis should be placed on bacterial culture and drug susceptibility testing,so as to reduce irrational drug use and the emergence of drug-resistant strains or superinfection.

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