老年医院获得性肺炎患者病原学及耐药性分析

Analysis of Pathogenesis and Drug Resistance in Elderly Patients with Hospital Acquired Pneumonia

目的分析老年医院获得性肺炎(hospital acquired pneumonia,HAP)患者的病原学分布及其耐药性,为临床合理用药提供依据。方法收集2019年1月—2021年12月辽宁省金秋医院/辽宁省老年病医院发生的HAP老年患者的临床资料,分析其病原微生物分布及耐药性。结果共收集老年HAP病例947例,年龄60~103岁,平均(91.01±3.68)岁,中位年龄91岁。应用抗生素前送检痰标本620份,培养病原菌菌株216株。其中,以G-菌感染为主,占97.7%,其中铜绿假单胞菌、肺炎克雷伯杆菌、不动杆菌、嗜麦芽糖寡养单胞菌、大肠埃希菌为主要致病菌,占比分别为34.7%、20.8%、9.7%、9.3%、8.8%。多重耐药菌株84例,占38.9%,其中包括泛耐药铜绿假单胞菌2例。2019—2021年3年间的多重耐药菌株率分别为16.9%,49.4%,和57.7%,呈现明显的逐年上升趋势。铜绿假单胞菌对亚胺培南、氨曲南、环丙沙星、头孢他啶、左氧氟沙星、哌拉西林/他唑巴坦的耐药率分别为28.0%、20.0%、17.3%、17.3%、16%。肺炎克雷伯杆菌对氨曲南、青霉素类、头孢类、喹诺酮类的耐药率菌较高,其中对氨苄西林的耐药率高达84.5%,对头孢曲松、头孢呋辛、头孢吡肟、头孢唑啉的耐药率均达到>50%。不动杆菌属对氨苄西林/舒巴坦、头孢曲松、头孢他啶、头孢噻肟耐药率较高,分别为42.9%、47.6%、42.9%、47.6%。嗜麦芽糖寡养单胞菌对头孢他啶呈现明显的耐药,达70%。大肠杆菌对氨曲南、青霉素类、头孢类、喹诺酮类的耐药率菌较高,均达到>50%。结论老年医院获得性肺炎患者感染病原菌仍以G-杆菌为主,且多重耐药率逐年增加,应根据药敏结果合理选用抗生素。

Objective To analyze the pathogenic distribution and their drug resistance in elderly patients with hospital acquired pneumonia(HAP),and to provide guidance for clinical medication.Methods Clinical data of elderly patients with HAP in Jinqiu Hospital of Liaoning Province/Liaoning Geriatric Hospital from January 2019 to December 2021 were collected.The pathogenic microbial distribution and drug resistance were analyzed.Results A total of 947 cases of HAP patients were collected,aged 60~103 years,with a mean age of(91.01±3.68)years and a median of 91 years.620 sputum specimens were examined before the application of antibiotics,and 216 strains of pathogenic bacteria were cultured.G-bacterial infections accounted for 97.7%of the cases,with Pseudomonas aeruginosa,Klebsiella pneumoniae,Bacillus immobilis,Oligotrophomonas maltophilia and Escherichia coli as the main causative agents,accounting for 34.7%,20.8%,9.7%,9.3%and 8.8%respectively.There were 84 cases(38.9%)of multi-drug resistant strains,including 2 cases of pan-drug resistant Pseudomonas aeruginosa.The rate of multi-drug resistant strains for the 3-year period(2019-2021)is 16.9%,49.4%,and 57.7%respectively,showing a clear year-on-year increase.The resistance rates of Pseudomonas aeruginosa to imipenem,aminotrans,ciprofloxacin,ceftazidime,levofloxacin and piperacillin/tazobactam were 28.0%,20.0%,17.3%,17.3%and 16%,respectively.The resistance rate of Klebsiella pneumoniae to aminotrans,penicillins,cephalosporins and quinolones is high,with the resistance rate to ampicillin reaching 84.5%and to ceftriaxone,cefuroxime,cefepime and cefazolin all reaching over 50%.Bacteroides immobilis spp.had higher resistance rates to ampicillin/sulbactam,ceftriaxone,ceftazidime and cefotaxime at 42.9%,47.6%,42.9%and 47.6%,respectively.Oligotrophomonas maltophilia showed significant resistance to ceftazidime,up to 70%.E.coli had a high rate of resistance to aminotrans,penicillins,cephalosporins and quinolones,all above 50%.Conclusion In elderly patients with hospital acquired pneumonia,the pathogenic bacteria are still predominantly G-bacteria,and the multi-drug resistance rate is increasing year by year,so antibiotics should be selected appropriately according to the drug sensitivity results.