【摘要】：目的：回顧性分析我院COPD急性加重期患者氣道分泌物標(biāo)本的病原菌分布和細(xì)菌耐藥率，為我院AECOPD患者應(yīng)用抗生素提供參考。 方法：系統(tǒng)性回顧分析2007年1月-12月、2011年1月-12月遼寧省人民醫(yī)院呼吸科病房AECOPD患者氣道分泌物標(biāo)本分離的211、186株病原菌分布及耐藥性。采用美國BD PHOENIX全自動(dòng)微生物鑒定/藥敏系統(tǒng)鑒定細(xì)菌菌株，用紙片擴(kuò)散法進(jìn)行藥敏試驗(yàn) 結(jié)果： 1.2007年共分離出211株病菌。革蘭氏陰性菌占78.20%，2007年分離細(xì)菌前三位分別為銅綠假單胞菌42株，肺炎克雷伯菌33株，鮑曼不動(dòng)桿菌29株，占總數(shù)49.29%。革蘭氏陽性菌占29.0%，，其中金黃色葡萄球菌17株，肺炎雙球菌6株，占總數(shù)10.9%。真菌17株，占總數(shù)8.06%。 2.2011年共分離出186株病菌。革蘭氏陰性菌76.88%，2011年分離細(xì)菌前三位分別為鮑曼不動(dòng)桿菌38株，銅綠假單胞菌30株，肺炎克雷伯菌23株，占總數(shù)48.92%。革蘭氏陽性菌12.9%，其中金黃色葡萄球菌15株，肺炎雙球菌3株，占總數(shù)9.68%。真菌19株，占總數(shù)10.22%。 3.2007年和2011年銅綠假單胞菌耐藥率超過50%的有：氨芐西林/舒巴坦、阿莫西林/克拉維酸、頭孢曲松。耐藥率維持在30%以下的抗生素有：亞胺培南、美羅培南、阿米卡星、慶大霉素。多粘菌素的敏感性為100%。與2007年對(duì)比，2011年銅綠假單胞菌對(duì)常見β-內(nèi)酰胺類、喹諾酮類抗生素耐藥率均有增加，其中耐藥率增加10%以上的有：頭孢曲松鈉、乳酸環(huán)丙沙星。 4.2007年和2011年肺炎克雷伯菌耐藥率超過50%的有：氨芐西林/舒巴坦、環(huán)丙沙星、左氧氟沙星。耐藥率維持在30%以下的抗生素有：慶大霉素、亞胺培南、美羅培南和頭孢吡肟。多粘菌素的敏感性為100%。較2007年，2011年肺炎克雷伯菌對(duì)常見β-內(nèi)酰胺類、喹諾酮類抗生素耐藥率多數(shù)有明顯增高，其中耐藥率增加10%以上的有：氨芐西林/舒巴坦、阿莫西林/克拉維酸、哌拉西林/他唑巴坦、頭孢他啶、頭孢吡肟、頭孢曲松、氨曲南、環(huán)丙沙星、左氧氟沙星。 5.2007年和2011年鮑曼不動(dòng)桿菌對(duì)耐藥率超過50%的有：氨芐西林/舒巴坦、阿莫西林/克拉維酸、頭孢曲松、氨曲南、環(huán)丙沙星、左氧氟沙星。沒有耐藥率維持在30%以下的抗生素。多粘菌素的敏感性為100%。較2007年，2011年鮑曼不動(dòng)桿菌對(duì)常見β-內(nèi)酰胺類、喹諾酮類抗生素耐藥率明顯上升，其中耐藥率增加10%以上的有：阿米卡星、慶大霉素、亞胺培南、美羅培南、頭孢哌酮/舒巴坦、頭孢他啶、頭孢曲松、氨曲南、左氧氟沙星。 結(jié)論： 1.我院AECOPD患者病原菌以革蘭氏陰性菌為主，2007年和2011年細(xì)菌分離結(jié)果類似，分別為78.20%、76.88%。 2.與2007年對(duì)比，2011年我院AECOPD患者前三位病原菌的分離率有變化，兩年中前三位病原菌均為：鮑曼不動(dòng)桿菌、銅綠假單胞菌、肺炎克雷伯菌，但鮑曼不動(dòng)桿菌分離率由2007年第三位上升為第一位。 3.與2007年對(duì)比，2011年分離的鮑曼不動(dòng)桿菌、肺炎克雷伯菌、銅綠假單胞菌對(duì)β-內(nèi)酰胺類、喹諾酮類抗生素耐藥率多數(shù)有明顯增高。肺炎克雷伯菌、銅綠假單胞菌對(duì)亞胺培南、美羅培南、頭孢吡肟、阿米卡星、慶大霉素耐藥率維持在30%以下。2011年鮑曼不動(dòng)桿菌耐藥率除多粘菌素外均超過30%。 4.臨床醫(yī)生應(yīng)重視病原菌檢測(cè)，了解本地區(qū)、本單位病原菌分布和耐藥趨勢(shì)，合理的經(jīng)驗(yàn)性選擇抗菌藥物。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9;R446.5

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