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目的:探讨老年慢性阻塞性肺疾病(COPD)继发院内革兰氏阴性杆菌感染的发病机理、菌型分布及耐药性。方法:从本院老年COPD继发医院革兰氏阴性杆菌(GNB)肺炎患者痰液中分离的213株GNB进行菌型分类,选用12种常用抗菌药物进行体外MIC药敏试验。结果:213株占COPD继发医院肺炎病原菌总数的69.6%(213/306)。老年COPD患者继发革兰氏阴性菌感染菌种分类为:铜绿假单胞菌(35.7%)、肺炎克雷伯菌(21.1%)、大肠埃希菌(17.4%)、阴沟肠杆菌(11.7%)、嗜麦芽假单胞菌(7.9%)、其他病原菌(6.1%);药敏结果表明,所有GNB对抗菌药物耐药率均呈上升趋势。结论:铜绿假单胞菌是COPD继发GNB感染的主要致病菌,在临床治疗中必须重视菌型鉴定和药敏试验,合理使用抗生素,才能控制院内感染GNB的发生和日益增高的耐药趋势。
Objective: To investigate the pathogenesis, bacterial distribution and drug resistance of Gram-negative bacilli in elderly patients with chronic obstructive pulmonary disease (COPD). Methods: 213 GNB isolated from the sputum of patients with Gram-negative bacilli (GNB) pneumonia secondary to COPD secondary to our hospital were tested for bacterial susceptibility by using 12 commonly used antimicrobial agents. Results: 213 strains accounted for 69.6% (213/306) of the total number of pneumococcal pathogens in COPD secondary hospitals. Gram-negative bacterial infections in elderly COPD patients were classified as Pseudomonas aeruginosa (35.7%), Klebsiella pneumoniae (21.1%), Escherichia coli (17.4%), Enterobacter cloacae %), Pseudomonas maltophilia (7.9%) and other pathogenic bacteria (6.1%). The results of drug susceptibility showed that all GNBs showed an upward trend in the rate of resistance to antibiotics. Conclusion: Pseudomonas aeruginosa is the main pathogen of secondary GNB infection in COPD. It is necessary to pay attention to the identification of bacteria and drug sensitivity test in clinical treatment. Rational use of antibiotics can control the occurrence of nosocomial infection of GNB and the increasing resistance trend.