老年非感染住院患者口咽部带菌情况研究

Oropharyngeal Bacterial Carriage in Hospitalized Elderly Patients Without Acute Infections

目的了解老年非感染住院患者口咽部细菌携带及其耐药的危险因素,以利医院感染的防治。方法以无菌生理盐水漱口后,采集咽拭子,进行细菌培养及鉴定。以纸片扩散法进行药敏测定。结果105例老年患者口咽部细菌携带率为55.2%;获分离菌62株,其中革兰阴性杆菌56株(90.3%),革兰阳性球菌5株(8.1%),白色假丝酵母菌1株(1.6%),34株嗜血菌属细菌对氨苄西林、头孢克洛等均100.0%敏感,部分菌株对庆大霉素及环丙沙星耐药,10株肺炎克雷伯菌中4株产超广谱β-内酰胺酶,对头孢噻肟等抗菌药物耐药;多因素回归分析显示,口腔装有义牙是老年人口咽部带菌的危险因素。结论老年住院患者口咽部细菌携带率高,主要携带菌为嗜血菌属等革兰阴性杆菌,口腔义牙是老年人口咽部带菌的危险因素。

OBJECTIVE To investigate the oropharyngeal bacterial carriage in hospitalized elderly patients without acute infections and the antimicrobial resistance, and the risk factors for the bacterial carriage. METHODS An oropharyngeal swab was taken from each patient after they rinsed their mouths with sterile saline. Bacteria were cultured and identified with routine methods and the antimicrobial susceptibility testing was carried out with disk diffusion method. RESULTS The oropharyngeal bacterial carriage rate was 55.2% in elderly patients. Sixty two pathogens were isolated including 56 （90.3% ） strains of Gram-negative bacilli, 5 （8.1%） Gram-positive cocci and 1 Candida albicans. All of 34 strains of Haemophilus spp were susceptible to antimicrobials tested such as ampicillin and cefaclor, a few strains were resistant to gentamicin and ciprofloxacin. Of 10 strains of Klebsiella pneumoniae, 4 strains were extended-spectrum β-lactamases positive and resistant to cefotaxime. Logistic analysis indicated that denture-wearing was the risk factor for the oropharyngeal bacterial carriage in elderly. CONCLUSIONS Oropharyngeal bacterial carriage rate is high in hospitalized elderly patients. The major colonized bacteria are Gram-negative bacilli. Denture-wearing is the risk factor for the oropharyngeal bacterial carriage in elderly.