老年慢性阻塞性肺病患者继发革兰氏阴性杆菌感染的菌型及耐药性分析

目的：探讨老年慢性阻塞性肺疾病（COPD）继发院内革兰氏阴性杆菌感染的发病机理、菌型分布及耐药性。方法：从本院老年COPD继发医院革兰氏阴性杆菌（GNB）肺炎患者痰液中分离的213株GNB进行菌型分类，选用12种常用抗菌药物进行体外MIC药敏试验。结果：213株占COPD继发医院肺炎病原菌总数的69．6％（213／306）。老年COPD患者继发革兰氏阴性菌感染菌种分类为：铜绿假单胞菌（35．7％）、肺炎克雷伯菌（21．1％）、大肠埃希菌（17．4％）、阴沟肠杆菌（11．7％）、嗜麦芽假单胞菌（7．9％）、其他病原菌（6．1％）；药敏结果表明，所有GNB对抗菌药物耐药率均呈上升趋势。结论：铜绿假单胞菌是COPD继发GNB感染的主要致病菌，在临床治疗中必须重视菌型鉴定和药敏试验，合理使用抗生素，才能控制院内感染GNB的发生和日益增高的耐药趋势。

Analysis of Organism Distribution and Drug Resistance in Chronic Obstructive Pulmonary Disease Patients with Gram-negative Bacteria infection

Objective： To study the nosogeny, organism distribution and current resistance of elderly chronic obstructive pulmonary disease （COPD） patients with nosocomial Gram negative bacteria infection. Methods： Two hundred and thirteen strains of （GNB） from COPD patients with nosocomial GNB infection were classified and drug resistance was analyzed. Twelve antibiotics susceptibility test of 213 GNB were carried by in vitro chemosensitivity assay. Results： GNB （213 strains） were 69.6% （213/306） in organism isolated from the patients with nosocomial infection. Most of the organism was Pseudom onas aeruginosa （ 35.7% ） the second was Klebsiella pneumoniae （ 21.1% ）, third was Escherichia Coli（ 17.4% ）, Enterobacter Cloacae （ 11.7% ）, Pseudomonas maltophilia （7.9%）. The resistance rate was in an increasing tendency. Conclusion： GNB are the major pathogen of elderly COPD patients with nosocomial Gram negative bacteria infection and their drug resistant rate are very high. The matter is horrible in clinics. We should enforce monitoring, are the main organism of COPD. In order to control the resistant tendency of COPD, antibiotic must be used reasonably.