Objective To investigate the sputum culture results of the elderly chronic obstructive pulmonary disease (COPD) with ventilator associated pneumonia (VAP) and their corresponding bacterial drug resistance to guide the clinical medication. Methods Selected 98 cases of elderly COPD patients with VAP in intensive care unit of 180th Hospital of PLA from 2015 May to 2017 May,collected sputum specimens after 24h in hospital,and collected 48h sputum of the patients who use mechanical ventilation after 48h after extubation and weaning pneumonia or pneumonia,sputum pathogen culture and drug sensitive test,compared the distribution and drug resistance of the pathogens between the two groups. Results One hundred and ninety-six specimens of 98 cases were Pathogen cultured,151 strains pathogenic bacteria were isolated;Patients admit-ted to hospital with 61 strains bacteria were cultured,the positive rate was 62.2%,occurred after the VAP 90 strains bacteria were cultured,the positive rate was 91.8%, the two groups was significant statistically difference (P<0.05). Pathogenic bacteria drug resistance analysis reveal ordinary beta lactam type with high resistance about pathogenic bacteria. Conclusion The pathogenic of elderly COPD and VAP patients dominated by gram negative bacterial infection, antibiotic resistance is higher,so the drug treatment experience to override common pathogenic bacteria, targeted selection of antibiotics to improve clinical cure rate.%目的 分析老年慢性阻塞性肺疾病(COPD)合并呼吸机相关性肺炎(VAP)的痰培养结果及其相对应的细菌耐药情况,指导临床用药.方法 选取2015年5月—2017年5月解放军第180医院重症病房COPD合并VAP老年患者98例作为研究对象,留取患者入院后24 h内痰液标本,同时收集使用机械通气后48 h后出现肺炎,或者拔管、脱机48 h内出现肺炎患者的痰液标本,进行病原培养和药物敏感试验,对比2组的病原学分布和耐药情况.结果98例患者共196份痰标本进行病原学培养,分离出致病菌151株;患者入院时培养出细菌61株,阳性率为62.2%,前3位致病菌为鲍曼不动杆菌、铜绿假单胞菌、肝炎克雷伯杆菌;发生VAP 后培养出细菌90株,阳性率为91.8%,前3位致病菌为鲍曼不动杆菌、肝炎克雷伯杆菌、铜绿假单胞菌,不同时间比较差异具有统计学意义(χ2=6.82,P=0.01).致病菌对普通β-内酰胺类具有较高耐药率.结论 老年COPD合并VAP患者的致病原中以革兰阴性菌感染为主,抗生素耐药率较高,因此治疗时经验用药要覆盖常见的致病菌,针对性地选用抗生素提高临床治愈率.
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