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目的分析慢性阻塞性肺疾病急性加重期患者感染病原菌种类及分布特征和耐药性。方法选取2012年1月至2015年1月在郏县人民医院接受治疗的慢性阻塞性肺疾病急性加重期患者190例。在患者入院后24 h内采痰标本,然后对标本进行培养,染色镜检,分离鉴定病原菌种类。对常见病原菌使用抗菌药物进行药敏试验,判断病原菌耐药性。结果 190例患者共分离病原菌230株。其中革兰阳性菌25株(10.87%),革兰阴性菌194株(84.35%),真菌11株(4.78%)。革兰阴性菌构成比明显高于革兰阳性菌和真菌,差异有统计学意义(P<0.05)。其中,铜绿假单胞菌48株,占20.87%,是最常见的病原菌,其次为鲍曼不动杆菌和肺炎克雷伯杆菌,各占19.13%、16.96%。铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯杆菌对氨苄西林耐药率均较高,分别为97.91%、68.18%以及97.44%;三种病原菌对左旋氧氟沙星耐药率较低,分别为25.00%、52.27%和10.26%。结论慢性阻塞性肺疾病急性加重期病原菌感染主要为革兰氏阴性菌,其中,铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯杆菌是常见病原菌,对不同病原菌进行药敏试验,观察其耐药性对于提高治疗效果至关重要。
Objective To analyze the types, distribution characteristics and drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease. Methods Totally 190 patients with acute exacerbation of chronic obstructive pulmonary disease who were treated in Shexian People’s Hospital from January 2012 to January 2015 were selected. In patients within 24 h after admission sputum specimens, and then cultured specimens, staining microscopy, identification of the pathogen species. The use of antimicrobial susceptibility testing of common pathogens to determine the pathogen resistance. Results A total of 230 pathogens were isolated from 190 patients. Among them, 25 (10.87%) were Gram-positive bacteria, 194 (84.35%) were Gram-negative bacteria and 11 (4.78%) were fungi. Gram-negative bacteria composition ratio was significantly higher than Gram-positive bacteria and fungi, the difference was statistically significant (P <0.05). Among them, 48 strains of Pseudomonas aeruginosa, accounting for 20.87%, were the most common pathogens, followed by Acinetobacter baumannii and Klebsiella pneumoniae, accounting for 19.13% and 16.96% respectively. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae showed high rates of resistance to ampicillin, which were 97.91%, 68.18% and 97.44%, respectively. The resistance rates of three pathogens to levofloxacin Lower, respectively, 25.00%, 52.27% and 10.26%. Conclusions The pathogenic bacteria infections of acute exacerbation of chronic obstructive pulmonary disease are mainly Gram-negative bacteria. Of these, Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae are common pathogens, they are susceptible to different pathogens, To observe the drug resistance is essential to improve the therapeutic effect.