慢性阻塞性肺疾病急性加重期临床病菌学分析
发布时间：2018-11-12 09:30
【摘要】：目的:探讨蚌埠医学院第二附属医院收治的慢性阻塞性肺疾病急性加重期患者痰细菌学培养结果及抗生素抗菌活性情况,以指导临床合理使用抗生素,有效控制感染。方法:收集蚌埠医学院第二附属医院呼吸内科病房2012年11月-2014年4月收治的AECOPD患者350例,具有完整的临床资料,其中男192例,女158例,年龄56~92岁,回顾性分析每位患者的痰细菌培养和药敏结果,明确各种细菌构成比和抗生素敏感情况。结果:1.350例AECOPD患者中送检215例,送检率为61.42%,共分离出病原菌154例,61例未检出病原菌,阳性率为71.62%;2.154例菌株中在检出致病菌中革兰氏阴性菌89株,占57.80%,假单胞菌属最多,共分离36株,其次为大肠杆菌21株(13.63%)、肺炎克雷伯杆菌17株(11.03%)、鲍曼不动杆菌15株(8.53%);真菌25例(14.02%),主要真菌为白色念珠菌18例(11.03%);40例(25.97%)革兰阳性细菌。3.亚胺培南、美罗培兰等碳青霉烯类抗生素对革兰阴性细菌最有效,头孢吡肟、头孢哌酮舒巴坦、替加环素对革兰阴性细菌的敏感率次于碳青霉烯类,其中亚胺培南对铜绿假单胞菌敏感率最高,敏感率99.57%,嗜麦芽窄食单胞菌对研究所用抗生素广泛耐药;对革兰阳性菌有效的抗生素为亚胺培南、万古霉素,亚胺培南对金黄色菌敏感率95.65%,万古霉素更对其绝对敏感。4.检出的真菌主要为白色念珠菌,检出对常用的抗真菌药物如氟胞嘧啶、制霉菌素、酮康唑等药物抗真菌活性相对较低,而抗真菌药物氟康唑、伊曲康唑、伏立康唑等药物抗真菌活性较高。结论:1.目前本地区临床上痰标本的送检率和培养率均较低,有待进一步提高。2.AECOPD患者的临床病原菌感染以革兰阴性杆菌为主,革兰阳性球菌也占有一定比例,真菌感染不容忽视。3二代头孢、三代头孢、青霉素类抗革兰阴性细菌活性差,而碳青霉烯类、四代头孢抗菌活性较高;革兰阳性球菌对对青霉素类、二代头孢敏感性差,对氨基糖苷类、四代头孢类、头霉素类敏感性较好,对万古霉素高度敏感;真菌感染对抗真菌药物均较敏感。4.嗜麦芽窄食单胞菌对研究所用抗生素广泛耐药。5.临床应加强病原学检测,根据药物敏感性结果合理选择使用抗菌药。
[Abstract]:Objective: to investigate the results of sputum bacteriological culture and antibacterial activity of antibiotics in patients with chronic obstructive pulmonary disease (COPD) in the second affiliated Hospital of Bengbu Medical College in order to guide rational use of antibiotics and control infection effectively. Methods: a total of 350 AECOPD patients were collected from the Department of Respiratory Medicine, second affiliated Hospital of Bengbu Medical College from November 2012 to April 2014, with complete clinical data, including 192 males and 158 females, aged 56 to 92 years. The results of sputum bacterial culture and antibiotic sensitivity were analyzed retrospectively. Results: of the 1.350 patients with AECOPD, 215 were examined, and the rate was 61.42. A total of 154 cases were isolated, 61 cases were not detected, the positive rate was 71.62%. Among the 2.154 strains, 89 were Gram-negative bacteria (57.80%), 36 were Pseudomonas, 21 were Escherichia coli (13.63%), 17 were Klebsiella pneumoniae (11.03%). Acinetobacter baumannii 15 strains (8.53%); The main fungi were Candida albicans in 18 cases (11.03%), gram-positive bacteria in 40 cases (25.97%) and gram-positive bacteria in 40 cases (25.97%). Carbapenem antibiotics such as imipenem and meropenem are the most effective for gram-negative bacteria, cefepime, cefoperazone sulbactam and tegacycline are less sensitive to gram-negative bacteria than carbapenems. The sensitivity of imipenem to Pseudomonas aeruginosa was the highest and the sensitivity rate was 99.57. The isolates of Stenotrophomonas maltophilia were widely resistant to antibiotics. The effective antibiotics for Gram-positive bacteria were imipenem, vancomycin, imipenem and imipenem, and the sensitivity rate of vancomycin to golden yellow bacteria was 95.65, and vancomycin was absolutely sensitive to it. 4. The main fungi detected were Candida albicans. The antifungal activities of common antifungal drugs such as fluocytosine, nystatin and ketoconazole were relatively low, while the antifungal drugs fluconazole and itraconazole were relatively low. Volconazole and other drugs have high antifungal activity. Conclusion: 1. At present, the rate of sputum examination and culture in this area is low, which needs to be further improved. Gram-negative bacilli are the main pathogenic bacteria in 2.AECOPD patients, Gram-positive cocci also account for a certain proportion. Fungal infection can not be ignored. 3 the second generation cephalosporium, the third generation cephalosporal, penicillin class anti-gram-negative bacteria activity is poor, but carbapenems, the fourth generation cephalosporal antibacterial activity is higher; Gram-positive cocci have poor sensitivity to penicillin, second generation cephalosporins, aminoglycosides, fourth generation cephalosporins, cephalomycin, and highly sensitive to vancomycin, and fungal infection antifungal drugs are more sensitive. 4. Stenotrophomonas maltophilia is widely resistant to antibiotics used in our institute. 5. Clinical etiology should be strengthened and antibiotics should be used rationally according to the results of drug sensitivity.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5;R563.9
本文编号：2326722
[Abstract]:Objective: to investigate the results of sputum bacteriological culture and antibacterial activity of antibiotics in patients with chronic obstructive pulmonary disease (COPD) in the second affiliated Hospital of Bengbu Medical College in order to guide rational use of antibiotics and control infection effectively. Methods: a total of 350 AECOPD patients were collected from the Department of Respiratory Medicine, second affiliated Hospital of Bengbu Medical College from November 2012 to April 2014, with complete clinical data, including 192 males and 158 females, aged 56 to 92 years. The results of sputum bacterial culture and antibiotic sensitivity were analyzed retrospectively. Results: of the 1.350 patients with AECOPD, 215 were examined, and the rate was 61.42. A total of 154 cases were isolated, 61 cases were not detected, the positive rate was 71.62%. Among the 2.154 strains, 89 were Gram-negative bacteria (57.80%), 36 were Pseudomonas, 21 were Escherichia coli (13.63%), 17 were Klebsiella pneumoniae (11.03%). Acinetobacter baumannii 15 strains (8.53%); The main fungi were Candida albicans in 18 cases (11.03%), gram-positive bacteria in 40 cases (25.97%) and gram-positive bacteria in 40 cases (25.97%). Carbapenem antibiotics such as imipenem and meropenem are the most effective for gram-negative bacteria, cefepime, cefoperazone sulbactam and tegacycline are less sensitive to gram-negative bacteria than carbapenems. The sensitivity of imipenem to Pseudomonas aeruginosa was the highest and the sensitivity rate was 99.57. The isolates of Stenotrophomonas maltophilia were widely resistant to antibiotics. The effective antibiotics for Gram-positive bacteria were imipenem, vancomycin, imipenem and imipenem, and the sensitivity rate of vancomycin to golden yellow bacteria was 95.65, and vancomycin was absolutely sensitive to it. 4. The main fungi detected were Candida albicans. The antifungal activities of common antifungal drugs such as fluocytosine, nystatin and ketoconazole were relatively low, while the antifungal drugs fluconazole and itraconazole were relatively low. Volconazole and other drugs have high antifungal activity. Conclusion: 1. At present, the rate of sputum examination and culture in this area is low, which needs to be further improved. Gram-negative bacilli are the main pathogenic bacteria in 2.AECOPD patients, Gram-positive cocci also account for a certain proportion. Fungal infection can not be ignored. 3 the second generation cephalosporium, the third generation cephalosporal, penicillin class anti-gram-negative bacteria activity is poor, but carbapenems, the fourth generation cephalosporal antibacterial activity is higher; Gram-positive cocci have poor sensitivity to penicillin, second generation cephalosporins, aminoglycosides, fourth generation cephalosporins, cephalomycin, and highly sensitive to vancomycin, and fungal infection antifungal drugs are more sensitive. 4. Stenotrophomonas maltophilia is widely resistant to antibiotics used in our institute. 5. Clinical etiology should be strengthened and antibiotics should be used rationally according to the results of drug sensitivity.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5;R563.9
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