老年糖尿病并发医院获得性下呼吸道感染患者的痰培养病原学分析

Hospital acquired low respiratory tract infection in elderly diabetic patients

目的 探讨老年糖尿病患者并发医院获得性下呼吸道感染的临床特点及病原学情况。 方法 回顾性调查分析老年糖尿病并发医院获得性下呼吸道感染 85例的临床资料、病原学及其耐药性的特点与糖代谢的关系。 结果 老年糖尿病并发医院获得性下呼吸道感染患者的病原菌以革兰阴性杆菌 (G-杆菌 )为主 ,占 73.9% ,主要为铜绿假单胞菌 1 8.2 %、肺炎克雷伯菌 1 5 9%、大肠杆菌1 4 8%。 2种细菌混合感染占 1 4 .1 % ,细菌与真菌并存占 6 .8%。药物敏感试验提示 :革兰阴性杆菌对抗生素的敏感性依次为头孢他啶 (Ceftazidime) 72 .3% ,氧氟沙星 (Ofloxacin) 70 .8% ,头孢曲松(Ceftriaxone) 6 3.1 % ,头孢噻肟 (Cefotaxime) 6 1 .5 % ,头孢哌酮 (Cefoperazone ) 6 1 .5 % ,头孢唑啉 (Ce fazolin) 6 0 .0 % ,哌拉西林 (Piperacillin) 5 3.8%。革兰阳性球菌对万古霉素 1 0 0 %敏感。血糖控制不好、基础疾病复杂、伴有并发症的老年糖尿病患者 ,并发医院获得性下呼吸道感染增多 ,且预后不良。 结论 糖尿病患者并发医院获得性下呼吸道感染常见 ,应在控制血糖的基础上根据药物敏感试验结果进行抗感染治疗。

Objective To investigate the clinical manifestation and pathogens of hospital acquired low respiratory tract infection in elderly patients with diabetes. Methods To the clinical data were analyzed retrospectively, the pathogens isolated from culture sputum and the antibiotic sensitivity of bacteria was determined in 85 elderly patients with diabetes. Results Bacilli in sputum were common in these patients (73.9%, including Pseudomonas aeruginosa 18.2%, Klebsiella pneumoniae 15 9%, Escherichia coli 14 8%). 14 cases were complicated with 2 different bacilli, and 6.8% with fungus. The bacilli sensitivity to antibiotics was as higher as 72.3% to ceftazidime, 70.8% to ofloxacin, 63.1% to ceftriaxone, 61.5% to cefoperazone or cefoperazone, 60.0% to cefazolin, 53.8% to piperacillin respectively. Cocci sensitivity was 100% to vancomycin. Uncontrolled hyperglycemia, severe basic diseases and diabetic complications were involved in the pathogenesis of hospital acquired low respiratory tract infection and the poor prognosis. Conclusion Hospital acquired infected low respiratory tract is common in elderly patients with diabetes, and should be treated based on the antibiotic sensitivity of bacteria and on metabolic control.