慢性阻塞性肺疾病急性加重期病原菌与其综合评估分级间关系的研究

目的研究慢性阻塞性肺疾病急性加重期（AEC0PD）病原菌分布及耐药情况，与其综合评估分级之间的关系。方法对2008年1月至2012年6月金华市第五医院住院142例AEC0PD患者的痰标本进行细菌培养和药物敏感试验;所有患者按慢性阻塞性肺疾病全球倡仪（GOLD）20U版的要求进行综合评估后分级为A级、B级、C级、D级。结果142例AEC0PD患者有99例患者分离到病原菌，共129株。其中，革兰阴性菌最多，占59.6%，依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌，体外药敏结果显示大部分革兰阴性菌对亚胺培南有较好敏感性（72% ）;革兰阳性菌占20. 9%，依次为金黄色葡萄球菌、肠球菌、肺炎链球菌，大部分革兰阳性菌对万古霉素有较好敏感性（85% ）;真菌占19. 3% ,分别为A色念珠菌、热带念珠菌等，对氟胞嘧啶、两性霉素、伊曲康唑、伏立康唑等敏感度高。混合感染占总患者的27.2%。A、B、C和D级AEC0PD患者，病原菌为革兰阴性菌的分别占46.6% ,50.0% ,59. 0%和66.0% ;真菌分别为6. 2%、12. 5%、20. 4%和24. 0% ；混合感染患者分别为15. 3%、23.0%、22. 9%和36. 8%。C级、D级患者革兰阴性菌和真菌检出率,混合感染率较A级、B级高（P 〈 0. 05 ）。结论AEC0PD患者病原菌以革兰阴性菌为主，真菌感染、混合感染率亦较髙,病原菌耐药现象严重,患者综合评估分级高。

Detection of relationship between pathogens of acute exacerbation of chronic obstructive pulmonary disease and comprehensive evaluation classification

Objective To study the relationship between distribution and drug resistance of AECOPD pathogens and comprehensive evaluation classification of AECOPD patients. Methods The sputum specimens of 142 AECOPD patients who hospitalized in JinhuaFifth Hospital from 2008 to 2012 were conducted by sputum culture and drug sensitivity test. After comprehensive assessment classificationaccording to GOLD（2011 ）,all patients were divided into A, B, C and D level. Results One hundred and twenty-nine pathogen strainswere isolated from 99 AECOPD patients （ 99/142 ）. In bacteria distribution, Gram-negative bacteria were predominant, accounting for59. 6%,most of which were Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumannii and Escherichia coli. The susceptibility tests in vitro showed that most Gram-negative bacteria were sensitive to Imipenem. Grampositive bacteria infection accounted for20. 9%,most of which were Staphylococcus aureus, Enterococcus and Streptococcus pneumoniae. Most Gram-positive bacteria were sensitive to vancomycin. Fungous infection accounted for 19. 3%,including Candida albicans and C. Tropicalis. They had a higher sensitivityto Fluorocystine,Amphotricin B,Itraconazole and Voriconazole. Mixed infection accounted for 27. 2% . The ratios of Gram-negative bacteria in AECOPD patients with A, B,C and D level were 46. 6% , 50. 0%,59. 0% , 66. 0% , respectively; fungi were 6. 2%,12. 5%,20.4% and 24. 0%,respectively ;and mixed infection were 15. 3%,23. 0%,22. 9% and 36. 8%,respectively. The detection rates of Gramnegative bacteria and fungi as well a s the mixed infection rates of patients in C, D level were higher than A, B level （P 〈0. 05）.Conclusion The dominant pathogen of AECOPD patients is Gram-negative bacteria. , fungous infection and mixed infection are alsohigh. The situation of drug resistance is serious, and the comprehensive evaluation classification of the patients is high.