摘要
目的分析研究老年慢阻肺急性加重(acute exacerbation of chronic obstructivepulmonary disease,AECOPD)患者痰液病原菌和药敏情况,为临床合理选择抗生素提供可靠依据。方法对131例老年AECOPD患者开展痰菌培养,并对检出病原菌进行药敏试验;同时,对其中54例患者进行肺炎支原抗体(Ig M)检测。结果 131例患者首份痰液标本合格者74.81%;在131份合格痰标本中,革兰阴性菌检出率56.49%,革兰阳性菌检出率16.03%,真菌检出率1.53%。54例患者中肺炎支原抗体(Ig M)阳性率16.67%;97株致病菌中革兰阴性菌占76.29%,以铜绿假单胞菌、肺炎克雷伯菌、卡他莫拉菌为主;革兰阳性菌占21.65%,以金黄色葡萄球菌、肺炎链球菌为主;真菌占2.06%;部分患者痰液中检出两种及以上病原菌。肺炎克雷伯菌、卡他莫拉菌、铜绿假单胞菌对亚胺培南、氨苄西林、头孢呋辛、环丙沙星及庆大霉素均有较高的耐药性;金黄色葡萄球菌、肺炎链球菌对亚胺培南、氨苄西林及头孢呋辛均具有较高的耐药性。结论老年AECOPD患者下呼吸道致病菌以革兰阴性菌为主,革兰阳性菌次之;同时,肺炎支原体感染不容忽视。革兰阴性菌和革兰阳性菌对常用抗生素具有较高的耐药性。临床实践中,应加强肺炎支原体检测,做好痰液标本采集过程中的质控,提高痰培养送检率,依据病原菌种类及药敏试验报告合理使用抗生素,提高老年AECOPD患者治疗疗效。
Objective To analyze pathogenic bacteria and drug sensitivity in sputum form elderly patients with the acute exacer- bation of chronic obstructive pulmonary disease （ AECOPD ） for providing a reliable basis for rational use of clinical antibiot- ics. Methods 131 cases of elderly patients with AECOPD wasconducted sputum culture and drug susceptibility testing of patho- gens and 54 patients were tested for pneumoniae antibodies IgM. Results 74. 81% patients＇ the first putum specimens of 131 cases was qualified, among 131 qualified sputum samples, the detection rate of gram negative bacteria was 56. 49% , gram posi- tive bacteria was 16.03% , and the fungi detection rate was 1.53% , in addition, some were detected two or more pathogens in the sputums. The lgM positive rate of mycoplasma pneumonia antibody was 16. 67% in 54 patients. In 97 strains of pathogenic bacteria, gram negative bacteria accounted was 76. 29% with Pseudornonas aeruginosa, KlebsieUa pneumonia and MoraxeUa ca- tarrhalis was main; and gram positive bacteria accounted for 21.65% with main Staphylococcus aureuz, Streptococcus pneumoni- ae dominated; meanwhile, fungi accounted for 2. 06% , and more than two kinds of pathogenic bacteria were detected in spu- tums of part of patients. Klebsiella pneumoniae, Moraxella catarrhalis and Pseudornonca~ aeruginosa had high drug resistance to all mipenem, ampicillin, cefuroxime, eiprofloxacin and gentamicin. But Staphylococcus aureus and Streptococcus pneumoniae had high drug resistance to imipenem, ampicillin and cefuroxime. Conclusion The main pathogens of lower respiratory tract patho- gens were gram negative bacteria in elderly patients with AECOPD, meanwhile, Mycoplusma pneumonia infection should not be ignored. Gram negative bacteria and gram positive bacteria had high drug resistance to commonly used antibiotics. In clinical prac- tice, we should strengthen the detection of Mycoplasma pneurnoniae in sputum samples and good quality control in the process of collecting, and improve sputum submission rate, then rational using antibiotics on the basis of the report type and drug sensitivi- ty test of pathogenic bacteria for improving the curative effect of elderly patients with AECOPD.
作者
杨艳荣
梁敏
YANG Yanrong LIANG Min(Baoji City Chinese Medicine Hospital, Shaanxi 721001 , China)
出处
《医学动物防制》
2017年第3期353-354,F0003,共3页
Journal of Medical Pest Control
关键词
老年
慢阻肺急性加重
痰培养
药敏
Old age
Acute exacerbation of chronic obstructive pulmonary disease
Sputum culture
Drug sensitivity
