目的 了解慢性阻塞性肺疾病(COPD)患者发生下呼吸道感的病原菌分布及耐药性,指导抗生素应用.方法 选取2012年1月至2015年12月COPD患者合并下呼吸道感染患者1772例,采集所有患者的痰液进行病原菌鉴定和药敏试验.结果 1772例患者痰细菌培养分离出致病菌707株,革兰阴性杆菌468株(66.2％),革兰阳性球菌109株(15.4％),真菌130株(18.4％).革兰阴性杆菌中以肺炎克雷伯菌(30.3％),铜绿假单胞菌(28.6％),流感嗜血杆菌(8.9％),鲍曼不动杆菌(6.7％),大肠埃希菌(6.5％),嗜麦芽窄食单胞菌(4.8％)为主要致病菌,革兰阳性球菌中以金黄色葡萄球菌(35.6％),肺炎链球菌(23.6％),表皮葡萄球菌(24.7％)为主要致病菌.根据药敏结果,对铜绿假单胞菌活性较强的有头孢他啶、头孢哌酮舒巴坦,对鲍曼不动杆菌较敏感的有亚胺培南、头孢哌酮舒巴坦.金黄色葡萄球菌和表皮葡萄球菌对青霉素的耐药率均为100.0％,均对万古霉素及替考拉宁敏感.结论 COPD患者合并下呼吸道感染以革兰阴性杆菌感染为主,耐药率较高,真菌感染比例也较高.抗菌药物的选用应根据药敏试验结果,应加强地区抗感染控制及耐药性监测.%Objective To investigate the distribution and drug resistance of pathogens causing lower respiratory tract infection in patients with chronic obstructive pulmonary disease (COPD) in Jiaxing area,and to guide the application of antibiotics. Methods From January 2012 to December 2015,1772 patients with chronic obstructive pulmonary disease complicated with lower respiratory tract infection were selected. Sputum samples of all patients were collected for identification of pathogenic bacteria and drug susceptibility test . Results The differences of curative effect in the two groups were significant (Z=-2.526,P=0.012). The total effective rate of the experimental group was higher than in the control group(χ2=5.073,P=0.024,OR=2.405,95％CI=1.104～5.237). There were significant differences of lung function and blood gas index in the two groups (P<0.05).The risk of acute exacerbation during the treatment course was lower in the experimental group than in the control group(χ2=5.618,P=0.018,OR=0.347,95％CI=0.162～0.8625). Conclusion Chronic obstructive pulmonary disease patients with lower respiratory tract infection were mainly gram-negative bacilli infection,higher drug resistance,fungal infection rate is higher. Antimicrobial agents should be selected according to the results of drug sensitivity test strengthen the area of anti infection control and drug resistance monitoring.
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