目的 調(diào)查行機(jī)械通氣的慢性阻塞性肺疾病急性加重( AECOPD) 患者下呼吸道標(biāo)本主要病原菌的構(gòu)成和耐藥情況, 為臨床治療提供依據(jù)。方法 將2008 年1 月至2009 年12 月呼吸ICU內(nèi)行機(jī)械通氣的AECOPD 患者分為社區(qū)感染組及醫(yī)院感染組。經(jīng)支氣管鏡防污染毛刷取得患者下呼吸道標(biāo)本進(jìn)行病原菌分離培養(yǎng)鑒定及藥敏試驗(yàn)。結(jié)果 共納入134 例, 其中社區(qū)感染組75 例,醫(yī)院感染組59 例。醫(yī)院感染組病原菌檢出率顯著高于社區(qū)感染組( 81. 4% 比54. 7% , P lt; 0. 01) 。社區(qū)感染組檢出G- 桿菌27 株( 55. 1% ) , G+ 球菌14 株( 28. 6% ) , 真菌8 株( 16. 3% ) 。醫(yī)院感染組檢出G- 桿菌34 株( 61. 8%) , G+ 球菌12 株( 21. 8% ) , 真菌9 株( 16. 4%) 。醫(yī)院感染組與社區(qū)感染組菌種構(gòu)成無(wú)顯著差異( P gt;0. 05) 。醫(yī)院感染組產(chǎn)超廣譜β-內(nèi)酰胺酶( ESBLs) 細(xì)菌檢出率高于社區(qū)感染組( 58. 8% 比37% , P lt; 0. 05) 。醫(yī)院感染組菌株對(duì)主要抗生素耐藥率高于社區(qū)感染組。結(jié)論 機(jī)械通氣AECOPD 患者下呼吸道病原菌耐藥現(xiàn)象嚴(yán)重, 醫(yī)院感染組較社區(qū)感染組更嚴(yán)重。真菌感染及耐藥性增多提示臨床醫(yī)師須重視合理用藥, 堅(jiān)持細(xì)菌耐藥性監(jiān)測(cè)及加強(qiáng)防控。
引用本文： 徐平,劉媛媛,宋衛(wèi)東,曾飛球,羅華,楊虹. COPD 急性加重機(jī)械通氣患者下呼吸道病原菌分布和耐藥現(xiàn)狀. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2010, 9(4): 348-352. doi: 復(fù)制
| 1. | 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)慢性阻塞性肺疾病學(xué)組. 慢性阻塞性肺疾病診治指南( 2007 年修訂版) . 中華結(jié)核和呼吸雜志,2007, 30: 8-17. |
| 2. | 中華人民共和國(guó)衛(wèi)生部. 醫(yī)院感染診斷標(biāo)準(zhǔn)( 試行) . ( 2001 年1月2 日頒布) . 南京: 東南大學(xué)出版社, 2001. |
| 3. | Clinical and Laboratory Standards Institute CLSI. 2006. Performance standards for antimicrobial susceptibility testing [ S] . sixteenth informational supplement.Wayne, Pa. |
| 4. | Nseir S, Di Pompeo C, Cavestri B, et al. Multiple diaig-resistant bacteria in patients with severe acute exacerbation of chronicobstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med, 2006 , 34 : 2959-2966. |
| 5. | Wilson R. Bacteria, antibiotics and COPD. Eur Respir J, 2001, 17 :995-1007. |
| 6. | Ram FS, Rodrignez-Roisin R, Granados-Navarrete A, et al.Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2006, 19 : CD004403. |
| 7. | Marquette CH, Herengt F, MathieuD, et al. Diagnostic of pneumonia in mechanically ventilated patients. repeatability of the protected specimen brush. Am Rev Respir Dis, 1993, 147: 211 -214. |
| 8. | Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis,2006, 43: S49-S56. |
| 9. | 武寧, 黃怡, 李強(qiáng), 等. 呼吸科重癥加強(qiáng)治療病房院內(nèi)肺部真菌感染47 例臨床分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 7: 182 -186. |
| 10. | Resende JC, de Resende MA, Saliba JL. Prevalence of Candida spp.in hospitalized patients and their risk factors. Mycoses, 2002, 45 :306-312. |
- 1. 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)慢性阻塞性肺疾病學(xué)組. 慢性阻塞性肺疾病診治指南( 2007 年修訂版) . 中華結(jié)核和呼吸雜志,2007, 30: 8-17.
- 2. 中華人民共和國(guó)衛(wèi)生部. 醫(yī)院感染診斷標(biāo)準(zhǔn)( 試行) . ( 2001 年1月2 日頒布) . 南京: 東南大學(xué)出版社, 2001.
- 3. Clinical and Laboratory Standards Institute CLSI. 2006. Performance standards for antimicrobial susceptibility testing [ S] . sixteenth informational supplement.Wayne, Pa.
- 4. Nseir S, Di Pompeo C, Cavestri B, et al. Multiple diaig-resistant bacteria in patients with severe acute exacerbation of chronicobstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med, 2006 , 34 : 2959-2966.
- 5. Wilson R. Bacteria, antibiotics and COPD. Eur Respir J, 2001, 17 :995-1007.
- 6. Ram FS, Rodrignez-Roisin R, Granados-Navarrete A, et al.Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2006, 19 : CD004403.
- 7. Marquette CH, Herengt F, MathieuD, et al. Diagnostic of pneumonia in mechanically ventilated patients. repeatability of the protected specimen brush. Am Rev Respir Dis, 1993, 147: 211 -214.
- 8. Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis,2006, 43: S49-S56.
- 9. 武寧, 黃怡, 李強(qiáng), 等. 呼吸科重癥加強(qiáng)治療病房院內(nèi)肺部真菌感染47 例臨床分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 7: 182 -186.
- 10. Resende JC, de Resende MA, Saliba JL. Prevalence of Candida spp.in hospitalized patients and their risk factors. Mycoses, 2002, 45 :306-312.