2007年与2011年AECOPD患者病原菌分布及耐药情况分析

发布时间：2018-11-13 18:34

【摘要】：目的：回顾性分析我院COPD急性加重期患者气道分泌物标本的病原菌分布和细菌耐药率，为我院AECOPD患者应用抗生素提供参考。方法：系统性回顾分析2007年1月-12月、2011年1月-12月辽宁省人民医院呼吸科病房AECOPD患者气道分泌物标本分离的211、186株病原菌分布及耐药性。采用美国BD PHOENIX全自动微生物鉴定/药敏系统鉴定细菌菌株，用纸片扩散法进行药敏试验结果： 1.2007年共分离出211株病菌。革兰氏阴性菌占78.20%，2007年分离细菌前三位分别为铜绿假单胞菌42株，肺炎克雷伯菌33株，鲍曼不动杆菌29株，占总数49.29%。革兰氏阳性菌占29.0%，，其中金黄色葡萄球菌17株，肺炎双球菌6株，占总数10.9%。真菌17株，占总数8.06%。 2.2011年共分离出186株病菌。革兰氏阴性菌76.88%，2011年分离细菌前三位分别为鲍曼不动杆菌38株，铜绿假单胞菌30株，肺炎克雷伯菌23株，占总数48.92%。革兰氏阳性菌12.9%，其中金黄色葡萄球菌15株，肺炎双球菌3株，占总数9.68%。真菌19株，占总数10.22%。 3.2007年和2011年铜绿假单胞菌耐药率超过50%的有：氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢曲松。耐药率维持在30%以下的抗生素有：亚胺培南、美罗培南、阿米卡星、庆大霉素。多粘菌素的敏感性为100%。与2007年对比，2011年铜绿假单胞菌对常见β-内酰胺类、喹诺酮类抗生素耐药率均有增加，其中耐药率增加10%以上的有：头孢曲松钠、乳酸环丙沙星。 4.2007年和2011年肺炎克雷伯菌耐药率超过50%的有：氨苄西林/舒巴坦、环丙沙星、左氧氟沙星。耐药率维持在30%以下的抗生素有：庆大霉素、亚胺培南、美罗培南和头孢吡肟。多粘菌素的敏感性为100%。较2007年，2011年肺炎克雷伯菌对常见β-内酰胺类、喹诺酮类抗生素耐药率多数有明显增高，其中耐药率增加10%以上的有：氨苄西林/舒巴坦、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、头孢曲松、氨曲南、环丙沙星、左氧氟沙星。 5.2007年和2011年鲍曼不动杆菌对耐药率超过50%的有：氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢曲松、氨曲南、环丙沙星、左氧氟沙星。没有耐药率维持在30%以下的抗生素。多粘菌素的敏感性为100%。较2007年，2011年鲍曼不动杆菌对常见β-内酰胺类、喹诺酮类抗生素耐药率明显上升，其中耐药率增加10%以上的有：阿米卡星、庆大霉素、亚胺培南、美罗培南、头孢哌酮/舒巴坦、头孢他啶、头孢曲松、氨曲南、左氧氟沙星。结论： 1.我院AECOPD患者病原菌以革兰氏阴性菌为主，2007年和2011年细菌分离结果类似，分别为78.20%、76.88%。 2.与2007年对比，2011年我院AECOPD患者前三位病原菌的分离率有变化，两年中前三位病原菌均为：鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌，但鲍曼不动杆菌分离率由2007年第三位上升为第一位。 3.与2007年对比，2011年分离的鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌对β-内酰胺类、喹诺酮类抗生素耐药率多数有明显增高。肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、美罗培南、头孢吡肟、阿米卡星、庆大霉素耐药率维持在30%以下。2011年鲍曼不动杆菌耐药率除多粘菌素外均超过30%。 4.临床医生应重视病原菌检测，了解本地区、本单位病原菌分布和耐药趋势，合理的经验性选择抗菌药物。
[Abstract]:Objective: To retrospectively analyze the distribution of pathogenic bacteria and the rate of bacterial drug resistance in patients with acute exacerbation of COPD in our hospital, and provide reference for the application of antibiotics in patients with AECOPD. Methods: From January to December, 2007, the distribution and tolerance of 211,186 pathogenic bacteria isolated from airway secretion in the respiratory department of the People's Hospital of Liaoning Province from January to December, 2011 were systematically reviewed. Drug properties. The bacterial strain was identified by the U. S. BD PHOENIX full-automatic microbial identification/ drug sensitive system, and the drug was used for drug diffusion. sensitivity test Results: 1. 2007 Among the 211 strains, the Gram-negative bacteria accounted for 78. 20%. The first three of the isolated bacteria in 2007 were 42 strains of Pseudomonas aeruginosa, 33 strains of Klebsiella pneumoniae, 29 strains of Abalone and 29 strains, respectively. The total number of Gram-positive bacteria was 49. 29%. Gram-positive bacteria accounted for 29. 0%, of which 17 strains of staphylococcus aureus and 6 strains of pneumococcus pneumoniae, in total, 10. 9% of that total, 17 of the fungus, Total 8. 06%. 2. 2011 A total of 186 strains were isolated in the year. The total number of Gram-negative bacteria was 71.88%. The first three strains of the isolated bacteria in 2011 were 38 strains of non-Acinetobacter baumannii, 30 strains of P. aeruginosa and 23 klebsiella pneumoniae. Strain, accounting for 48. 92% of total, 12. 9% of Gram-positive bacteria, 15 of S. aureus and 2. 3 strains, 9. 68% of total. Fungal 19 The resistance rate of Pseudomonas aeruginosa in more than 50% in 2007 and 2011 was: methicillin/ sulbactam, Amoxicillin/ clavulanic acid, ceftriaxone. The resistance rate is maintained below 30% of the antibiotics are: imipenem, Meropenem, amikacin, gentamicin The sensitivity of polymyxin is 100%. In contrast to 2007, P. aeruginosa in 2011 has an increase in the resistance rate of the common opioid-endometamine and the lennoone antibiotics, in which the resistance rate is increased by more than 10%. There are: ceftriaxone sodium, ciprofloxacin lactate. 4. In 2007 and 2011, the resistance rate of klebsiella pneumoniae is over 50%. penicillin/ sulbactam, ciprofloxacin, levofloxacin. The drug resistance rate is maintained below 30%. The antibiotic is: Qing-Da mycin, imipenem, meropenem, and head The sensitivity of polymyxin is 100%. In 2007, K. pneumoniae in 2011 has a marked increase in the resistance rate of the common opioid-endometamine, and the rate of antibiotic resistance of the Lennoone class, of which the resistance rate is increased by more than 10%, such as: methicillin/ sulbactam, amoxicillin/ clavulate, and amoxicillin/ clavulate. dimensional acid, zlocillin/ other sulbactam, cefotaxime, cefixime, cefixime, Ammoxicillin/ sulbactam, amoxicillin/ clavulanic acid,, ceftriaxone, amcinolone, ciprofloxacin, left oxyfluoride, sand star. No drug resistance rate is maintained at 30% The sensitivity of the following antibiotics is 100%. South, ceftriaxone/ sulbactam, He, ceftriaxone, amcinolone, levofloxacin. Conclusion: 1. The pathogenic bacteria of AECOPD in our hospital are Gram-negative bacteria, and in 2007 and 2011 The results of the annual bacterial separation were 78. 20%, 76. 88%. 2. In comparison with 2007, the separation rate of three pathogenic bacteria in the patients with AECOPD in our hospital was changed in 2011. Leibbidium, but the separation rate of the Abalone was increased from the third in 2007 to the first. 3. In contrast to 2007, the isolated Abalanobacter baumannii, Klebsiella pneumoniae, and Klebsiella pneumoniae were isolated in 2011. The drug-resistance rate of P. aeruginosa was significantly higher than that of P. P. P. P. P. P., P. aeruginosa, P. aeruginosa, P. aeruginosa, Miropenem, Cefixime, amikacin and gentamicin. In 2011, the drug-resistance rate of the Baumannii was more than 30% in addition to polymyxin. The clinical doctor should attach importance to the pathogenic bacteria.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9;R446.5

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