老年患者呼吸道感染致病菌的菌群分布及其耐药监测

Distribution and Drug Resistance of Pathogens in Senile Patients with Respiratory Tract Infection

目的了解老年患者呼吸道感染致病菌的菌群分布特点及常见致病菌对抗菌药物的耐药情况,为临床合理使用抗生素提供依据。方法收集湖北省15所三级甲等医院2002年呼吸道感染老年患者细菌培养分离的致病菌,对其进行耐药性监测。药敏采用K-B法,用WHONET-5软件进行数据分析。结果共收集致病菌2 373株。其中革兰阴性菌1 822株(76.8%),革兰阳性菌551株(23.2%)。最常见的革兰阴性菌为铜绿假单胞菌(20.9%)、克雷伯菌属(14.7%)、不动杆菌属(7.5%),最常见的革兰阳性菌为链球菌属(7.4%)、表皮葡萄球菌(5.5%)、金黄色葡萄球菌(4.2%)。86.9%的表皮葡萄球菌和62.6%的金黄色葡萄球菌对甲氧西林耐药,但无万古霉素耐药株。2.1%的肠球菌对万古霉素耐药。18.1%的克雷伯菌和30.2%的大肠埃希菌产生超广谱β-内酰胺酶(ESBLs),亚胺配南、头孢哌酮-舒巴坦、头孢他啶和阿米卡星对革兰阴性菌有良好的抗菌活性,但与1996年湖北省的监测资料比较,耐药率有所上升。结论老年患者呼吸道感染以革兰阴性菌为优势菌株,且耐药性日益严重,对亚胺配南、头孢哌酮-舒巴坦、头孢他啶、阿米卡星最为敏感。对革兰阳性菌宜以万古霉素为首选。

Objective To investigate the distribution of pathogens isolated from the senile patients with respiratory tract infection and the drug resistance of the commonly seen pathogens to antibiotics, Methods All the pathogens isolated from sputum of the senile patients with respiratory tract infection in 15 hospitals of Hubei province were collected during 2002. Bacterial susceptibility test was carried out by using Kirby-Bauer method. A WHONET-5 computer software was used to analyze the resuits. Results 2 373 strains including 1 822 strains （76.8%） of gram negative bacilli and 551 strains （23.2 %） of gram positive cocci were collected. Plasmotas aeruginosa, Klebsiella. Acinetobacter. Streptococcus, Heamophilus, E. coli, Epidermis staphylococci, Enterobacter, Sterotrophomonas and S. aureus were the main microorganisms. 86.9 % of E. staphylococci and 62.6 % of S. aureus were resistant to oxicillin, but not to vancomycin. 2. 1 % of enterococcus was resistant to vancomycin. 18.1 % of Klebsiella and 30.2 % of E. coli produced extended-spectrum β-lactamase. The active agents against gram negative organisms were imipenem, amikacin, ceftazidine sulperazone and cipnofloxacin, while the susceptible rate was significantly lower than the data reported by Hubei province in 1996. Conclusion The drug resistance of clinical bacteria in the senile patients with respiratory tract infection is serious increasingly. Gram negative bacilli were the main stains, and were susceptible to imipenen, amikacin and cefatazidine. Vancomycin was the first choice to treat the infection with gram positive cocci.