老年人下呼吸道感染病原菌分布及耐药性分析

STUDIES ON PATHOGENIC BACTERIA AND ITS RESISTANCE IN ELDERLY PATIENTS WITH LOWER RESPORATORY TRACT INFECTION

目的：了解我院呼吸内科60岁以上老年患者下呼吸道感染病原菌的分布及耐药性分析。方法：用传统方法和VITEK32型全自动细菌分析系统对我院2004年3月至2005年9月呼吸内科门诊及住院患者分离出的387株病原菌进行鉴定，药敏试验用纸片扩散法，NCCLS标准判定结果。结果：革兰阳性菌仍以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主；革兰阴性杆菌依次是大肠杆菌，肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆、阴沟杆菌；真菌占9．6％。耐甲氧西林的金黄色葡萄球菌（71．6％），产超广谱β-内酰胺酶ESBLS）的肺炎克雷伯菌（33．3％），产ESLBLS的大肠杆菌（27．6％）。耐甲氧西林金黄色葡萄球菌（MRSA）对大多数抗生素耐药率均较高，未发现耐万古酶素菌株。大肠杆菌对亚胺培南、头孢吡肟、头孢替坦、头孢他啶、哌拉西林／三唑巴坦、头孢曲松等耐药率为0％～24．6％；肺炎克雷伯菌对多种抗生素耐药率比大肠杆菌较低；铜绿假单胞菌对大多数抗生素耐药率均较高。结论：老年人下呼吸道感染要及时准确地检测病原菌，进行药敏实验，指导临床医生合理应用抗生素。

Objective： To study the pathogenic bacteria and its drug resistance in the patients over 60 years old with lower resporatory tract infection in the Internal Medicine Department of Resporatory of our hospital. Methods： The 387 strains of pathegenic bateria separated from the patinets in outpatient department and in patient department of Internal Medicine of Resporatory in our hos- pital from Mar. 2004 to Sept. 2005 were identified by traditional methods and Entively VITED32, Auto Microbe System, drug resistance and NCCLS standard. Results： The pathogenic bacteria with exsited in the lower resporatory tract infections in the elderly are Gram- positive bacteria, Gram- negative bacteria and fungus. For Gram- postive bacteria, the main kids of which are S. aureus, coagulase negative Staphylococcus. For Gram-negative bacteria, that were E. coil, K. pneumoniae, P. aeruginosa, A. baumannii, E. cloacae. Fungusonly accounted for9.6%. S. attreus against Methicillin accounted for 71.6%, ESBLS-producing kiebsiella pneumoniae strains accounted for 33.3%, and ESBLS- producing E. colistrains, accounted for 27.6%. The drug resistance of S. aurfjus against Methicillin （MRSA） is higher, and it was not found that bacteria strains which against vanecomycin. The resistance rates of E. col against imipenem, cefoxitin, Cefotetan disodium＇ ceftazidine, piperacillin/tazo bactam, Ceftriaxone sodiumare ranged from 0 to 24.6% ; the rate of klebsieua pneumoniae against many antibiotics was lower than that of colon bacillus; The rate of P. aeruginosa against many antibiotics was higher. Conclusion： The elderly patients with lower resporatory tract infection should detected the pathogenic bacteria on time and correctly, and drug resistance experiments should be carried on, so as to guide doctor to use the most suitable antibiotics.