目的 了解慢性阻塞性肺疾病急性加重期(AECOPD)住院患者的痰培养结果及耐药性,为临床合理应用抗菌药物提供依据.方法 选取2014年8月-2016年8月在承德医学院附属医院住院的痰培养结果阳性的AECOPD患者147例,分析其痰培养和抗菌药物敏感性试验结果.结果 147例AECOPD患者的痰标本中共分离出158株病原体,革兰阴性菌94株(59.5％),其中铜绿假单胞菌36株(22.8％),对环丙沙星、丁胺卡那霉素、亚胺培南的耐药率较低,分别为19.4％、19.4％、16.7％;肺炎克雷伯菌24株(15.2％),对常用抗菌药物的耐药率较低(均＜35.0％);鲍曼不动杆菌20株(12.6％),对β-内酰胺类药物呈现较高的耐药率(均≥40％).革兰阳性菌36株(22.8％),其中肺炎链球菌16株(10.1％),对克林霉素耐药率高(87.5％);金黄色葡萄球菌12株(7.6％),除万古霉素、替考拉宁及利奈唑胺外,对其他抗菌药物的耐药率较高(均＞66.0％).真菌28株(17.7％),其中白色假丝酵母菌18株(11.4％),对氟康唑的耐药率为16.7％,对其他抗真菌药物均敏感.结论 AECOPD住院患者痰培养的病原体以革兰阴性菌为主,不同病原体的耐药特征不同,临床治疗时应根据病原体种类,针对性选择抗菌药物,以提高治疗效果.%Objective To investigate the distribution and resistance to antimicrobial agents of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),so as to provide a reference for clinical reasonable use of antimicrobial agents.Methods We analyzed the positive results of sputum culture and findings of antimicrobial susceptibility testing of 147 patients with AECOPD who received inpatient treatment in Affiliated Hospital of Chengde Medical University between August 2014 and August 2016.Results A total of 158 isolates were cultured from the sputum samples of theparticipants.Of them,59.5％ (94/158) were gram-negative bacteria,which mainly included Pseudomonas aeruginosa,accounting for 22.8％ of the total (36/158),Klebsiellapneumoniae,accounting for 15.2％ of the total (24/158),and Acinetobacterbaumannii,accounting for 12.6％ of the total (20/158).Pseudomonas aeruginosa isolates showed low resistance rate to ciprofloxacin (19.4％),amikacin (19.4％),and imipenem (16.7％).Klebsiellapneumoniaeisolates showed low resistance rate to commonly used antibiotics (all ＜ 35.0％).Acinetobacterbaumanniiisolates showed a high resistance rate to β -lactams.Thirty-six isolates [22.8％ (36/158)] were gram-positive bacteria,mainly included Streptococcus pneumoniae,accounting for 10.1％ of the total (16/158),and Staphylococcus aureus,accounting for 7.6％ of the total (12/158).Streptococcus pneumonia isolates were highly resistant to clindamycin (87.5％).Staphylococcus aureusisolates were sensitive to vancomycin,teicoplanin,linezolid and resistant to the other antibiotics.There were 28 isolates [17.7％ (28/158)] belonging to fungi,which were mainly Candida albicans [11.4％ (18/158)],16.7％ of which were resistant to fluconazole and sensitive to other antifungal drugs.Conclusion Gram-negative bacteria arethe main pathogens for AECOPD inpatients.As the drug resistance characteristics of pathogens differ significantly by thepathogentype,so antimicrobial agents should be used reasonably based on the type of pathogens in order to improve the success rate of treatment.
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