老年患者医院获得性肺炎菌群分类及耐药性分析

Pathogen spectrum and drug resistance of hospital acquired pneumonia in senile patients

目的探讨老年患者医院获得性肺炎致病菌的菌群分布及其对抗生素的耐药情况,为临床合理使用抗生素提供依据。方法回顾调查我院2004年3月—2007年9月123例老年医院获得性肺炎患者的临床资料,分析病原学及细菌学特点、抗生素的耐药监测。结果共收集致病菌141株,其中革兰氏阴性菌83株(59.0%),革兰氏阳性菌33株(23.4%),真菌25株(17.6%)。革兰氏阴性菌中铜绿假单胞菌检出率最高(19.2%),其次为大肠埃希氏菌(11.4%),肺炎克雷伯氏菌(7.8%),62.5%的大肠埃希氏菌产超广谱β-内胺酰酶,45.5%肺炎克雷伯氏菌产超广谱β-内胺酰酶。革兰氏阴性菌对亚胺培南/西司他丁、阿米卡星、头孢吡肟的敏感性较高,而对氨苄西林、环丙沙星、复方新诺明的耐药率大都在50%以上。革兰氏阳性菌以金黄色葡萄球菌最多见(14.9%),其次为肠球菌(5.0%)。革兰氏阳性菌对头孢唑林、头孢噻肟、环丙沙星、亚胺培南/西司他丁的耐药率多在67%以上,而对万古霉素敏感性高,尚未发现耐万古霉素的葡萄球菌菌株。结论老年患者医院获得性肺炎以革兰氏阴性杆菌为优势菌株,且耐药性日趋严重,对亚胺培南/西司他丁、阿米卡星、头孢吡肟敏感性较高。革兰氏阳性球菌感染宜以万古霉素为首选。

Objective To study the clinical antibiotic use by analyzing the pathogens spectrum and drug resistance of hospital acquired pneumonia isolated from senile patients. Methods Clinical data of 123 senile patients with nosocomial pneumonia from March 2004 to September 2007 were reviewed. The pathogen types and antibiotic sensitivity of pathogens isolated from cultured sputum collected from the patients were analyzed. Results One hundred and forty-one strains including 83 strains of Gram-negative bacteria （59.0%）, 33 strains of Gram-positive bacteria （23.4%）, 25 strains of fungi （ 17.6% ） were collected. Pseudomonas aeruginosa （19.2%）, Encherichia coli （11.4% ） and Klebsiella pneumonia （7.8%） were the main microorganisms and 62.5 % of Encherichia coli and 45.5 % of Klebsiella pneumonia were suspected to produce extended-spectrum β-lactamase. The effective agents against Gram-negative bacteria were Imipenem/Cilastatin, Amikacin and Cefepime, while the drug resistance rate of Gram-negative bacteria to Ampicillin, Ciprofloxacin and Co-trimoxazole were above 50%. The drug resistance rate of Gram-positive bacteria to Cefazolin, Cefotaxime, Ciprofloxacin, Imipenem and Cilastatin were almost above 67% while most Gram-positive bacteria were sensitive to Vancomycin. Conclusion The drug resistance of bacteria in senile patients with nosocomial pneumonia is increasing. Gram-negative bacteria are the main pathogens and susceptible to Imipenem/Cilastatin, Amikacin and Cefepime while Vancomycin is the first choice to treat the infection of Gram-postitive bacteria in these patients.