老年下呼吸道流感嗜血杆菌感染的临床分析

Analysis of Lower Respiratory Tract Infection by Haemophilus Infiuenzae in the Elderly

目的探讨老年下呼吸道感染的危险因素、感染情况及该菌对常用抗生素的耐药性,为治疗提供帮助。方法回顾分析50例老年下呼吸道流感嗜血杆菌感染患者的临床资料。用K-B法测定该菌的体外药物敏感性。结果全部患者均有基础疾病,其中以慢性阻塞性肺疾病(COPD)38例(76.0%)为多,还有糖尿病9例(18.0%);晚期肿瘤7例(14.0%),脑血管病2例(4.0%)。临床表现和胸部影像学检查符合下呼吸道感染。药敏试验提示该菌呈现多重耐药。其中对氟哌嗪青霉素、磺苄青霉素及并用β内酰胺酶抑制剂,或单用含酶抑制剂的第三代头孢菌素保持敏感性。但有13例使感染再染,认为可能是该菌向L型变异所致。结论老年下呼吸道流感嗜血杆菌感染多发生于慢性支气管炎、细支气管炎特别是弥漫性泛细支气管等的基础疾病,如反复感染终归由绿脓杆菌所替代。目前的耐药现象严重,并且耐药菌株还在不断增加。治疗应根据病原学检查及药物敏感试验。

Objective To analyse risk factors and infection state of 50 cases with lower respiratory tract infection caused by haemophilus influenzae in the elderly and to investigate the drug sensitivities of haemophilus influenzae strains, then to help the antibiotic therapy. Methods Retrospective study of the clinical materials of 50 cases of lower respiratory tract infection caused by haemophilns influenzae in the elderly. The drug sensitivities against the haemophilus influenzae strains were determined by Kirby-Bauer method. Results All of 50 cases had serious underlying diseases, most of which were COPD, 38 eases （76.0%）; nine cases were diabetes （18.0%）; seven cases were late tumor （14.0%）; two eases were eerebralvascnlar disease （4.0%）. No specific clinical manifestations and chest X-ray appearance were reversed, The antimicrobial tests showed that these strains were muhiresistant to antibiotics, but piperacillin, HuangBiancillin or combined with lS-lactamase inhibitors were sensitive, third-generation eephalosporins with enzyme inhibitors were sensitive too, 13 cases were relapsed, which maybe caused by L- mutation of haemophilus influenzae. Conclusions Lower respiratory tract infection caused by haemophilus influenzae in the elderly were commonly seen in patients who suffered from various underlying diseases, such as chronic bronchitis, capillary bronchitis, espedally diffuse capillary bronchitis. If infection happens repeatedly, it will be developed to bacterium aeruginosum in the end. Now clinical isolates are higldy resistant to most of antimicrobial agents, and resistant strains are on the increase. Antibiotics therapy should be made according to bacteridagie examination and antimicrobial sensitivity test.