鄂尔多斯地区导致患者慢性阻塞性肺疾病急性加重的病原菌研究

摘要

目的 了解鄂尔多斯地区慢性阻塞性肺疾病急性加重期(AECOPD)患者的病原菌分布及耐药情况,为该地区临床合理应用抗菌药物提供理论依据.方法 对该地区2013-2015年372例AECOPD患者的痰培养及药敏结果进行分析,评估患者出现急性加重期前的生活质量.结果 372例患者共分离病原菌296株,其中革兰阴性菌252株(85.14%),主要包括铜绿假单胞菌(58株,19.59%)、肺炎克雷伯菌(51株,17.23%)、鲍曼不动杆菌(50株,16.89%)、嗜麦芽窄食单胞菌(22株,7.43%)、大肠埃希菌(19株,6.42%)、阴沟肠杆菌(16株,5.41%);真菌27株(9.12%),以白假丝酵母菌(19株,6.42%)为主;革兰阳性菌17株(5.74%),以金黄色葡萄球菌为主.其中CAT评分≥10分的患者分离铜绿假单胞菌、鲍曼不动杆菌所占比例高于CAT评分<10分的患者.结论 AECOPD患者的致病菌仍以革兰阴性菌为主,加重期前CAT评分可能与其出现急性加重时的致病菌有关.%Objective To understand the distribution and antimicrobial resistance of pathogens isolated from patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in Ordos area,so as to provide guidance for rational antimicrobial use.Methods Sputum culture and antimicrobial susceptibility testing results of 372 patients with AECOPD in Ordos area in 2013-2015 were analyzed,and the quality of life before acute exacerbation was assessed.Results A total of 296 strains of pathogens were isolated from 372 patients,252(85.14%)of which were gram-negative bacteria,the major were Pseudomonas aeruginosa(n=58,19.59%),Klebsiella pneumoniae(n=51,17.23%),Acinetobacter baumannii(n=50,16.89%),Stenotrophomonas maltophilia(n=22,7.43%),Escherichia coli(n=19,6.42%),and Enterobacter cloacae(n=16,5.41%);27(9.12%)were fungi,the major was Candida albicans(n=19,6.42%);17(5.74%)were gram-positive bacteria,the predominant species was Staphylococcus aureus.Patients with CAT(COPD assement test)score≥10 had higher proportion of isolating Pseudomonas aeruginosa and Acinetobacter baumannii than those with CAT score<10.Conclusion The main pathogens from patients with AECOPD are gram-negative strains,CAT score prior to exacerbation may be related to the emergence of pathogens at AECOPD.