摘要目的 探讨慢性阻摩性肺疾病急性加重期(AECOPD)住院患者细菌分布情况、耐药现状及细菌分布与病情严重程度的关系.方法 回顾性分析2007年1月至2008年12月在长治医学院附属和平医院呼吸科诊断为AECOPD的患者146例,研究其感染细菌种类及分布特点、与病情严重性的关系及其耐药情况.结果 ①146例AECOPD患者中84例痰培养出菌株,62例痰培养无黹株生长,阳性率为57.53%(84/146);分离菌株92株(8例复合感染),以革兰阴性杆菌为主,细菌感染依次是:鲍曼不动杆菌13株(14.13%).大肠埃希菌10株(10.87%).肺炎克雷伯杆菌7株(7.61%).阴沟肠杆菌7株(7.61%),铜绿假单胞菌5株(5.43%).②AECOPD患者随着肺功能损害程度的加重,常伴革兰阴性杆菌感染的增加.③革兰阴性杆菌对头孢菌素类、氟喹诺酮类、氨基糖苷类及碳青霉烯类均产生耐药.结论 AECOPD住院患者细菌分布以革兰阴性杆菌为主.包括鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯杆菌、阴沟肠杆菌和铜绿假单胞菌等.细菌分布与AECOPD患者肺功能损害程度有关,随着肺功能损害程度加重,革兰阴性杆菌的分离率增加.细菌耐药现象较为严重,革兰阴性杆菌对头孢菌素类耐药性较高,但对亚胺培南、阿米卡星的敏感性尚可.

abstractsObjective Studies on bacteria distribution,drug resistance and the relationshiP between the bacteria distribution and acute exacerbation of pulmonary function in patients with AECOPD in hospital,Methods lnformation of 146 patients with AECOPD at the Department of Respiratory,the First Affiliated HospitaI of Changzhi Medical College from January 2007 to December 2008 was collected.Characteristics of Bacteria distribution,its relationship with severity of disease and drug resistance were studied by retrospective analysis.Results ①84 of 146 AECOPD cases were found the growth of bacteria or fungi in sputum culturet;the other 62 cases were not.The positive rate is 57.53%(84/146).A total of 92 pathogens were isolated,the majority of which are gram-negative bacilli,the top 5 bacterial infections are Acinetobacter baumannii 13 strains(14.13%),Escherichia coli 10 strains(10.87%),Klebsiella pneumoniae 7 strains (7.61%),Enterobacter cloacae 7 strains(7.61%),Pseudomonas aeruginosa 5 strains(5.43%).②It is common that the detection rate of Pseudomonas,Enterohacter and Acinetobacter increases along with AECOPD Datients are exacerbated.③The testing for bacterial susceptibility shows that gram-negattVe bacilli are resistant to cephalosporins,quinolones,aminoglycosides and carbopenems at all.Conclusions Gramnegative bacteria is the majority on the composition of bacteria of AECOPD patients,including acinetobacter baumannii,escherichia coli,klebsiella pneumoniae,enterobacter cloacae,pseudomonas aeruginosa,etc.It is found the relationship between bacteriology of sputum culture results and damage of lung function.Usually the AECOPD patients'lung function is exacerbated along with the high detection rate of Pseudomonas,Enterobacter and Acinetobacter.The testing results on drug susceptibility show severe drug resistance.Grarn-negative bacilli is high resistant to cephalosporins and penicillin,and normal sensible to imipenem and amikacin.