摘　要：研究慢阻肺合并肺部感染患者的病原菌分布及药敏情况，以期为临床抗生素的正确使用提供依据。从长沙某医院2017年3月—2022年2月慢阻肺合并肺部感染患者痰培养标本检出的病原菌中随机筛选了1 500株进行培养鉴定及药敏试验，统计并分析病原菌的分布情况以及检出的主要革兰氏阴性菌（肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌）的耐药特点及趋势。结果发现：1 500株病原菌中共检出革兰氏阴性菌1 251株（83.40%），其中比例居前的分别是肺炎克雷伯菌384株（25.60%）、铜绿假单胞菌333株（22.20%）和鲍曼不动杆菌303株（20.20%）；革兰氏阳性菌126株（8.40%），其中比例居前的分别是金黄色葡萄球菌69株（4.60%）、肺炎链球菌27株（1.80%）；真菌123株（8.20%），主要为白色念珠菌96株（6.40%）。药敏分析结果显示：肺炎克雷伯菌对庆大霉素、左氧氟沙星、头孢他啶及氨曲南的耐药率变化具有统计学意义（P<0.05）；铜绿假单胞菌对于氨曲南的耐药趋势具有统计学意义（P<0.05）；鲍曼不动杆菌对于大多数抗菌药物均具有较高的耐药率，且对于左氧氟沙星、复方新诺明、美罗培南的耐药趋势具有统计学意义（P<0.05）。抗感染是治疗慢阻肺的一个重要措施，及时正确的选择敏感抗生素是关键环节。本研究为临床精准选择合适的抗菌药物治疗慢阻肺提供了帮助，同时有助于了解本地区细菌耐药的发展趋势，具有重要的临床价值和意义。
关键词：慢性阻塞性肺疾病（慢阻肺）；肺部感染；病原菌分布；药物敏感性；细菌耐药
中图分类号：R37                                   文献标志码：A                  DOI：10.3969/j.issn.1007-7146.2022.05.008

Abstract: This paper aims to study the distribution and drug sensitivity of pathogenic bacteria in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary infection, so as to provide the basis for the correct use of clinical antibiotics. 1 500 strains of pathogenic bacteria were randomly selected from sputum culture samples of patients with COPD complicated with pulmonary infection in a hospital in Changsha from March 2017 to February 2022 for culture identification and drug sensitivity test. The distribution of pathogenic bacteria and the drug resistance characteristics and trends of the main Gram-negative bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii) were counted and analyzed. A total of 1 251 strains (83.40%) of Gram-negative bacteria were detected from 1 500 pathogenic bacteria, of which 384 strains (25.60%) were Klebsiella pneumoniae, 333 strains (22.20%) were Pseudomonas aeruginosa, and 303 strains (20.20%) were Acinetobacter baumannii were the top. 126 strains of Gram-positive bacteria (8.40%) were detected from 1 500 pathogenic bacteria, of which 69 strains of Staphylococcus aureus (4.60%) and 27 strains of Streptococcus pneumoniae (1.80%) were the top. 123 strains of fungi (8.20%) were detected from 1 500 pathogenic bacteria, mainly 96 strains of Candida albicans (6.40%). The results of drug sensitivity analysis showed that the change of drug resistance rate of Klebsiella pneumoniae to Gentamicin, Levofloxacin, Ceftazidime and Aztreonam was statistically significant (P<0.05). The drug resistance trend of Pseudomonas aeruginosa to Aztreonam was statistically significant (P<0.05). Acinetobacter baumannii showed a high resistance rate to most antibiotics, and the resistance trend to Levofloxacin, Cotrimoxazole and Meropenem is statistically significant (P<0.05). Anti-infection is an important measure in the treatment of COPD, and timely and correct selection of sensitive antibiotics is the key link. This study provides help for the clinically accurate selection of appropriate antibiotics for the treatment of COPD, and also helps to understand the development trend of bacterial resistance in this region, which has important clinical value and significance.
Key words: chronic obstructive pulmonary disease (COPD); pulmonary infection; distribution of pathogenic bacteria; drug sensitivity; bacterial resistance
（Acta Laser Biology Sinica, 2022, 31(5): 433-439）