医院老年患者败血症诱因与病原菌耐药性分析

Risk Factors and Pathogenic Drug Resistance of Elderly Patients with Septicemia in Hospital

目的 探讨医院老年患者败血症的诱因以及病原菌耐药性。方法 选择我院1999年3月～2004年6月住院老年患者败血症病例30例，回顾性分析其诱因、病原菌分布及其对抗菌药物的耐药情况。结果 基础疾病：2型糖尿病10例次（占33．33％），心血管疾病9例次（占30．00％），肾功能不全和脑血管意外各5例次；在发病前7例（23．33％）施行了穿刺导管深静脉留置；41株病原菌中G^＋菌6株（14．6％），G^-菌27株（65．9％），真菌8株（19．5％）；病原菌分布老年组真菌比例高于非老年组（P=0．05）；对G^-杆菌敏感性良好的药物是哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、亚胺培南／西司他丁、左氧氟沙星、头孢曲松；而耐药性较高的是磺胺甲嗯唑／甲氧苄啶、氨苄西林；真菌对制霉菌素、两性霉素B敏感。结论 基础疾病较多、各种侵袭性操作、尤其是静脉导管留置是医院老年患者败血症的诱因；G^-菌是主要致病菌；老年组真菌比例明显高于非老年组；哌拉西林／他唑巴坦、头孢哌酮／舒巴坦，亚胺培南／西司他丁是良好的治疗药物。

OBJECTIVE To investigate the risk factors and pathogenic drug resistance of elderly patients with septicemia in hospital. METHODS Data were collected from the 30 cases of elderly patients with septicemia in hospital from Mar 1999 to Jun 2004. A retrospective study was made for risk factors, pathogen distribution and antimicrobial resistance. RESULTS Their underlying diseases were as follows： 10 cases of diabetes mellitus （33.33%）, 9 cases of cerebrovaseular diseases （30.00%）, 5 cases of renal dysfunction and 5 cases of cerebral vascular stroke, respectively. Intravenous indwelling catheter was made in 7 cases （23.33%）. Among 41 strains of pathogens, there were 6 strains of G^＋ ones （14. 6%）, 27 strains of G （65. 9%）, and 8 cases of fungi （19.5%）. Fungus ratio in elderly group was higher than that of non-elderly group（P=0.05）. The drugs which showed sound antimicrobial effect to major G^- bacilli were： piperacillin/tazobactam, cefoperazone/sulbactam, imipenem/cilastatin, levofloxacin, and ceftriaxone. But sulfamethoxazole/trimethoprim and ampicilllin showed highly resistant. Ceftazidime was relatively sensitive to Pseudomonas aeruginosa and Acinetobacter. Fungus was sensitive to fungicidin and amphotericin B. CONCLUSIONS Underlying diseases, various kinds of invasive manipulation, especially intravenous indwelling catheter are the risk factors of elderly septicemia in hospital. G- bacteria are the major pathogens. Fungus ratio in elderly group is significantly higher than that of non-elderly. Some drugs have satisfactory antimicrobial effect, for example piperacillin/tazobactam, cefoperazone/sulbactam, and imipen- em/cilastatin.