摘 要
慢性阻塞性肺疾病（COPD）急性加重期的病原菌分布及耐药性特征是临床治疗的关键问题，本研究旨在探讨COPD急性加重期患者下呼吸道感染病原菌构成及其耐药性变化规律。选取某三甲医院2018年1月至2022年12月收治的567例COPD急性加重期住院患者的痰液、支气管肺泡灌洗液等标本进行回顾性分析，采用常规细菌培养鉴定技术确定病原菌种类，并通过 Kirby - Bauer 纸片扩散法测定常见抗菌药物敏感性。结果显示共分离出843株病原菌，其中革兰阴性菌占69.8%，以铜绿假单胞菌、肺炎克雷伯菌为主；革兰阳性菌占26.7%，金黄色葡萄球菌较为常见；真菌占3.5%。耐药性方面，铜绿假单胞菌对亚胺培南、美罗培南的耐药率分别为34.2%和31.8%，肺炎克雷伯菌对头孢他啶、哌拉西林 / 他唑巴坦的耐药率分别为41.5%和37.9%，金黄色葡萄球菌中甲氧西林耐药株（MRSA）检出率为52.9%。本研究创新性地对不同年龄段、合并症情况下的病原菌分布及耐药性进行了分层分析，发现年龄≥65岁且伴有糖尿病或心血管疾病的患者更易感染多重耐药菌。结论为COPD急性加重期病原菌以革兰阴性菌为主，耐药现象严重，临床应重视个体化经验性抗感染治疗方案的选择，针对高危人群采取预防措施，减少耐药菌产生，提高治疗效果。
关键词：慢性阻塞性肺疾病急性加重；病原菌分布；耐药性特征；革兰阴性菌；多重耐药菌感染
Abstract
The distribution and antibiotic resistance characteristics of pathogens during acute exacerbations of chronic obstructive pulmonary disease (COPD) are critical issues in clinical management. This study aimed to investigate the composition and resistance patterns of lower respiratory tract infection pathogens in patients with acute exacerbation of COPD. A retrospective analysis was conducted on sputum and bronchoalveolar lavage fluid samples from 567 hospitalized patients with acute exacerbation of COPD at a tertiary hospital between January 2018 and December 2022. Pathogens were identified using conventional bacterial culture techniques, and antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. A total of 843 isolates were identified, with Gram-negative bacteria accounting for 69.8%, predominantly Pseudomonas aeruginosa and Klebsiella pneumoniae; Gram-positive bacteria accounted for 26.7%, with Staphylococcus aureus being common; and fungi accounted for 3.5%. Regarding antibiotic resistance, Pseudomonas aeruginosa exhibited resistance rates of 34.2% to imipenem and 31.8% to meropenem, while Klebsiella pneumoniae showed resistance rates of 41.5% to ceftazidime and 37.9% to piperacillin/tazobactam. The detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 52.9%. This study innovatively performed stratified analyses of pathogen distribution and resistance based on different age groups and comorbidities, revealing that patients aged ≥65 years with diabetes or cardiovascular diseases were more prone to infections with multidrug-resistant organisms. The conclusion is that pathogens in acute exacerbations of COPD are predominantly Gram-negative bacteria with significant antibiotic resistance. Clinicians should emphasize individualized empirical antimicrobial treatment strategies, implement preventive measures for high-risk populations, reduce the emergence of resistant strains, and improve therapeutic outcomes.
Keywords：Acute Exacerbation Of Chronic Obstructive Pulmonary Disease；Pathogen Distribution；Drug Resistance Characteristics；Gram-Negative Bacteria；Multidrug-Resistant Bacterial Infection
目 录
摘 要 I
Abstract II
引 言 1
第一章 病原菌分布特征分析 2
1.1 样本采集与处理方法 2
1.2 主要病原菌种类统计 2
1.3 不同季节病原菌差异 3
第二章 耐药性检测结果研究 5
2.1 耐药性检测方法建立 5
2.2 常见抗生素耐药情况 5
2.3 多重耐药菌株分析 6
第三章 影响因素综合探讨 8
3.1 患者基础疾病关联 8
3.2 住院时间对分布影响 8
3.3 抗生素使用史分析 9
第四章 预防与控制策略建议 11
4.1 合理使用抗生素原则 11
4.2 医院感染防控措施 11
4.3 未来研究方向展望 12
结 论 13
参考文献 14
致 谢 15
