2026 年第 1 期 第 21 卷

慢性阻塞性肺疾病合并呼吸道感染患者痰培养致病菌及耐药性分析

Analysis of the pathogenic bacteria and drug resistance of sputum culture in patients with chronic obstructive pulmonary disease complicated with respiratory tract infection

作者：朱信誉1李芳1何薇1蒋丽娟1朱婷婷1陈利娟2王爱月1

英文作者：Zhu Xinyu1 Li Fang1 He Wei1 Jiang Lijuan1 Zhu Tingting1 Chen Lijuan2 Wang Aiyue1

单位：1江苏省苏北人民医院呼吸与危重症医学科，扬州225000；2苏州大学附属第一医院肿瘤科，苏州215000

英文单位：1Department of Respiratory and Critical Care Medicine Northern Jiangsu People′s Hospital Jiangsu Province Yangzhou 225000 China; 2Department of Oncology the First Affiliated Hospital of Soochow University Suzhou 215000 China

关键词：慢性阻塞性肺疾病；呼吸道感染；致病菌；耐药性

英文关键词：Chronicobstructivepulmonarydisease;Respiratorytractinfection;Pathogenicbacteria;Drugresistance

• 摘要：

• 目的 探讨慢性阻塞性肺疾病（COPD）合并呼吸道感染患者痰培养致病菌的分布特征及其耐药性。方法 选取2023年1月至2024年12月在江苏省苏北人民医院与苏州大学附属第一医院诊治的COPD合并呼吸道感染患者作为研究对象。收集患者的临床资料及痰样本，经痰培养后进行病原菌检测及耐药性分析。结果 本研究共纳入628例患者，根据痰液样本将患者分为痰培养阳性组（416例）和痰培养阴性组（212例）。2组性别、年龄、年份、感染月份、COPD病程比较，差异均无统计学意义（均P＞0.05）。病原菌检测结果显示革兰阳性菌177株（33.6%）、革兰阴性菌324株（61.5%）、真菌26株（4.9%）。革兰阳性菌以金黄色葡萄球菌81株（45.8%）、肺炎链球菌54株（30.5%）、表皮葡萄球菌28株（15.8%）为主；革兰阴性菌以肺炎克雷伯菌112株（34.6%）、鲍曼不动杆菌96株（29.6%）、铜绿假单胞菌83株（25.6%）为主。主要革兰阳性菌对青霉素、阿奇霉素及左氧氟沙星呈现较高耐药率，而对万古霉素、替考拉宁和利奈唑胺均表现为完全敏感；主要革兰阴性菌中肺炎克雷伯菌及鲍曼不动杆菌对氨苄西林、阿莫西林/克拉维酸、环丙沙星、庆大霉素、左氧氟沙星、妥布霉素及头孢类抗菌药物耐药率较高，对亚胺培南、美罗培南等碳青霉烯类药物耐药率较低。铜绿假单胞菌对氨苄西林、头孢曲松、阿莫西林/克拉维酸的耐药率较高，对庆大霉素、妥布霉素、亚胺培南、美罗培南及大多数头孢类药物的耐药性较低。结论 COPD合并呼吸道感染患者所感染的病原菌复杂多样，且对临床一线抗菌药物耐药率较高；在治疗过程中，应及时进行痰培养及药敏试验，以指导临床合理用药。

• Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in sputum culture of patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory tract infection. Methods COPD patients with respiratory tract infection who were diagnosed and treated in Northern Jiangsu People′s Hospital, Jiangsu Province and the First Affiliated Hospital of Soochow University from January 2023 to December 2024 were selected as the research objects. The clinical data and sputum samples of the patients were collected, and the pathogen detection and drug resistance analysis were performed after sputum culture. Results A total of 628 patients were enrolled in this study. According to sputum samples, the patients were divided into sputum culture positive group (416 cases) and sputum culture negative group (212 cases). There were no significant differences in gender, age, year, infection month, and COPD course between the two groups (all P＞0.05). The results of pathogen detection showed that 177 strains (33.6%) were Gram-positive bacteria, 324 strains (61.5%) were Gram-negative bacteria, and 26 strains (4.9%) were fungi. The main Gram-positive bacteria were Staphylococcus aureus (81 strains, 45.8%), Streptococcus pneumoniae (54 strains, 30.5%) and Staphylococcus epidermidis (28 strains, 15.8%). Gram-negative bacteria were mainly Klebsiella pneumoniae (112 strains, 34.6%), Acinetobacter baumannii (96 strains, 29.6%), and Pseudomonas aeruginosa (83 strains, 25.6%). The main Gram-positive bacteria showed high resistance rates to penicillin, azithromycin and levofloxacin, but were completely sensitive to vancomycin, teicoplanin and linezolid. Among the main Gram-negative bacteria, Klebsiella pneumoniae and Acinetobacter baumannii had high resistance rates to ampicillin, amoxicillin/clavulanic acid, ciprofloxacin, gentamicin, levofloxacin, tobramycin and cephalosporins, and low resistance rates to carbapenems such as imipenem and meropenem. Pseudomonas aeruginosa had high resistance rates to ampicillin, ceftriaxone, amoxicillin/clavulanic acid, and low resistance to gentamicin, tobramycin, imipenem, meropenem and most cephalosporins. Conclusion  The pathogens in COPD patients with respiratory tract infection are complex and diverse, and the resistance rate to clinical first-line antibiotics is high. During the treatment, sputum culture and drug sensitivity test should be performed in time to guide clinical rational drug use.