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目的:探讨慢性阻塞性肺疾病急性加重期病原学特点及细菌耐药情况,为临床合理使用抗生素提供科学依据。方法:回顾性分析我院呼吸内科和老年学科2008年1月-2009年1月563例慢性阻塞性肺疾病(急性加重期)住院患者痰培养及药敏试验结果。结果:563例患者中检出阳性结果205例,检出率为36.41%。其中G+菌46例、G-菌119例、真菌40例。G+菌以金黄色葡萄球菌最多(14例),其次为表皮葡萄球菌和草绿色链球菌;G-菌以铜绿假单胞菌最多(37例),其次为克雷伯菌;真菌以白色念珠菌最多(20例)。G-杆菌对氨苄西林、哌拉西林、头孢唑啉、复方新诺明耐药严重,对亚胺培南、含β-内酰胺酶抑制剂的联合制剂较敏感。金黄色葡萄球菌对多种抗生素严重耐药,对万古霉素、亚胺培南较敏感。真菌对氟康唑敏感占50.81%,对伊曲康唑敏感占30.12%,对酮康唑敏感占30.83%,对5-氟胞嘧啶敏感占10.74%。结论:慢性阻塞性肺疾病急性加重期以G-为主,真菌感染有增多趋势,病原菌呈现多重耐药现象。
Objective: To investigate the etiological characteristics and bacterial resistance of patients with chronic obstructive pulmonary disease in acute exacerbations, and to provide a scientific basis for the rational use of antibiotics in clinical practice. Methods: A retrospective analysis of our hospital respiratory medicine and Geriatrics January 2008 - January 2009 563 cases of chronic obstructive pulmonary disease (acute exacerbation) inpatients sputum culture and drug sensitivity test results. Results: Of the 563 patients, 205 were positive, with a detection rate of 36.41%. Among them, 46 cases of G + bacteria, 119 cases of G-bacteria and 40 cases of fungi. Staphylococcus aureus was the most (14 cases) in G + bacteria, followed by Staphylococcus epidermidis and Streptococcus viridans; G- bacteria was the most (37 cases) with Pseudomonas aeruginosa, followed by Klebsiella; fungus with white rosary Most bacteria (20 cases). G- Bacillus ampicillin, piperacillin, cefazolin, cotrimoxazole resistance serious, imipenem, β-lactamase inhibitor combination preparations are more sensitive. Staphylococcus aureus is highly resistant to many antibiotics and more susceptible to vancomycin and imipenem. Fungus sensitive to fluconazole accounted for 50.81%, sensitive to itraconazole accounted for 30.12%, sensitive to ketoconazole 30.83%, sensitive to 5-fluorocytosine accounted for 10.74%. Conclusion: G-based acute mycosis of chronic obstructive pulmonary disease (COPD) has an increasing trend of fungal infection and multi-drug resistance of pathogens.