【摘要】 目的探讨慢性阻塞性肺疾病(COPD)伴医院获得性肺炎(HAP)患者的革兰阴性菌分布及耐药情况,为临床诊疗提供依据。方法回顾性调查2009-01~2014-09住院的68例COPD合并HAP患者呼吸道标本的细菌分离和药敏试验资料,分析革兰阴性菌种类分布及耐药率。结果 68例患者中分离出革兰阴性菌147株,其中鲍曼不动杆菌92株(62.6%),铜绿假单胞菌32株(21.8%),肺炎克雷伯杆菌10株(6.8%),其他革兰阴性菌13株(8.8%)。鲍曼不动杆菌对常用抗生素的耐药率明显增高,分别为头孢呋辛96.7%、头孢他啶94.6%、庆大霉素92.4%、环丙沙星92.4%等。肺炎克雷伯菌对哌拉西林、头孢呋辛、环丙沙星的耐药率较高,分别为50.0%、60.0%、90.0%。铜绿假单胞菌耐药率较低。结论 COPD合并HAP的常见革兰阴性菌为鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯杆菌。鲍曼不动杆菌为多重耐药菌,对抗生素耐药率高。临床医师应重视对患者鲍曼不动杆菌感染的预防和控制,合理应用抗生素。更多还原

【Abstract】 Objective To study the distribution and drug resistance of Gram-negative bacilli in patients with chronic obstructive pulmonary disease( COPD) complicated with hospital-acquired pneumonia( HAP),and to provide the evidences for clinical diagnosis and treatment. Methods The bacteria were isolated from the specimens in the respiratory tract in 68 patients with COPD complicated with HAP from January 2009 to September 2014,and their drug susceptibilities were tested. The distribution and drug resistance of Gram-negative bacilli in the isolated specimens were retrospective analysed. Results One hundred and forty-seven strains of gram-negative bacilli were isolated from68 patients,including 92 strains of Acinetobacter baumannii( 62. 6%),32 strains of Pseudomonas aeruginosa( 21. 8%),10 strains of Klebsiella pneumonia( 6. 8%),and 13 strains of other gram-negative bacilli( 8. 8%). The drug resistance rates of Acinetobacter baumannii to levofloxacin,ceftazidime,cefepime,imipenem,piperacillin /tazobactam and cefoperazone / sulbactam were 73. 9%,94. 6%,81. 5%,65. 2%,62. 0% and 55. 4%,respectively. The resistance rates of Klebsiella pneumonia to piperacillin,cefuroxime and ciprofloxacin were 50. 0%,60. 0%and 90. 0% respectively. The resistance rates of Pseudomonas aeruginosa to the above common antibiotics were lower. Conclusion The common Gram-negative bacilli isolated from the patients with COPD complicated with HAP are Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumonia in which Acinetobacter baumannii is a multidrug-resistant pathogen. Clinicians should pay more attention to the prevention and treatment of infection caused by Acinetobacter baumannii in patients and use antibiotics properly.更多还原