慢性阻塞性肺疾病急性加重期臨床病菌學(xué)分析
發(fā)布時間：2018-11-12 09:30
【摘要】：目的:探討蚌埠醫(yī)學(xué)院第二附屬醫(yī)院收治的慢性阻塞性肺疾病急性加重期患者痰細菌學(xué)培養(yǎng)結(jié)果及抗生素抗菌活性情況,以指導(dǎo)臨床合理使用抗生素,有效控制感染。方法:收集蚌埠醫(yī)學(xué)院第二附屬醫(yī)院呼吸內(nèi)科病房2012年11月-2014年4月收治的AECOPD患者350例,具有完整的臨床資料,其中男192例,女158例,年齡56~92歲,回顧性分析每位患者的痰細菌培養(yǎng)和藥敏結(jié)果,明確各種細菌構(gòu)成比和抗生素敏感情況。結(jié)果:1.350例AECOPD患者中送檢215例,送檢率為61.42%,共分離出病原菌154例,61例未檢出病原菌,陽性率為71.62%;2.154例菌株中在檢出致病菌中革蘭氏陰性菌89株,占57.80%,假單胞菌屬最多,共分離36株,其次為大腸桿菌21株(13.63%)、肺炎克雷伯桿菌17株(11.03%)、鮑曼不動桿菌15株(8.53%);真菌25例(14.02%),主要真菌為白色念珠菌18例(11.03%);40例(25.97%)革蘭陽性細菌。3.亞胺培南、美羅培蘭等碳青霉烯類抗生素對革蘭陰性細菌最有效,頭孢吡肟、頭孢哌酮舒巴坦、替加環(huán)素對革蘭陰性細菌的敏感率次于碳青霉烯類,其中亞胺培南對銅綠假單胞菌敏感率最高,敏感率99.57%,嗜麥芽窄食單胞菌對研究所用抗生素廣泛耐藥;對革蘭陽性菌有效的抗生素為亞胺培南、萬古霉素,亞胺培南對金黃色菌敏感率95.65%,萬古霉素更對其絕對敏感。4.檢出的真菌主要為白色念珠菌,檢出對常用的抗真菌藥物如氟胞嘧啶、制霉菌素、酮康唑等藥物抗真菌活性相對較低,而抗真菌藥物氟康唑、伊曲康唑、伏立康唑等藥物抗真菌活性較高。結(jié)論:1.目前本地區(qū)臨床上痰標(biāo)本的送檢率和培養(yǎng)率均較低,有待進一步提高。2.AECOPD患者的臨床病原菌感染以革蘭陰性桿菌為主,革蘭陽性球菌也占有一定比例,真菌感染不容忽視。3二代頭孢、三代頭孢、青霉素類抗革蘭陰性細菌活性差,而碳青霉烯類、四代頭孢抗菌活性較高;革蘭陽性球菌對對青霉素類、二代頭孢敏感性差,對氨基糖苷類、四代頭孢類、頭霉素類敏感性較好,對萬古霉素高度敏感;真菌感染對抗真菌藥物均較敏感。4.嗜麥芽窄食單胞菌對研究所用抗生素廣泛耐藥。5.臨床應(yīng)加強病原學(xué)檢測,根據(jù)藥物敏感性結(jié)果合理選擇使用抗菌藥。
[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.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5;R563.9
本文編號：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.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.5;R563.9
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相關(guān)期刊論文 前5條
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