老年患者医院获得性肺炎病原菌及耐药性监测

Detection of pathogenic bacteria and antibiotic resistance from hospital-acquired pneumonia in senile patients

目的明确广州地区老年医院获得性肺炎（hospital—acquired pneumonia，HAP）患者致病菌的构成情况及耐药情况，以期指导临床治疗。方法2004年1月至2005年10月在广州市4家医院住院、年龄≥60岁且分离出致病菌的HAP患者共206例，进行致病菌的分离鉴定，采用纸片扩散法进行细菌药敏检测。结果本组206例老年HAP患者平均年龄（76．6±8．3）岁，平均发病时间为21d，94．4％为迟发型HAP。共分离致病菌308株，其中革兰阴性细菌占65．3oA，革兰阳性细菌占26．3%，白色念珠菌占8．4％。前3位致病菌分别为铜绿假单胞菌（19．2％）、金黄色葡萄球菌（12．7％）、肺炎克雷伯菌（9．1％）。革兰阳性菌和革兰阴性菌均耐药情况严重。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌比例高达92．3％，溶血性葡萄球菌100％为耐甲氧西林溶血性葡萄球菌。金黄色葡萄球菌对万古霉素耐药率为2．6％。革兰阴性细菌对三代头孢菌素均严重耐药，铜绿假单胞菌呈广泛性严重耐药，有15株铜绿假单胞菌对所有抗生素均耐药。结论广州地区老年HAP患者细菌耐药性严重，必须加强措施防治其发病。

Objective To determine the distribution of pathogenic bacteria of hospital-acquired pneumonia（HAP） in senile patients in Guangzhou and their antibiotic resistance, and to instruct the clinic antibiotic treatment. Methods Patients aged over 60 years old,who were diagnosed of HAP with confirmed pathogens in four hospitals of Guangzhou, were put into study. Pathogens were identified, then the antibiotic resistance was determined by Kirty-Baucer disk diffusion assay. Results Average age of 206 old patients were （76.6 ± 8.3） years old. Mean onset time was 21 days. The late-onset HAP accounted for 94.4 %. There were 308 strains of pathogenic bacteria,including gram-negative bacteria accounted for 65.3 %, gram-positive bacteria accounted for 26.3 %, and Candida alhicans accounted for 8.4 %. The first three pathogens were Pseudomonas aeruginosa（ 19.2 % ）, Staphylococcus aureus （ 12.7 % ） and Klebsiella pneumonia （ 9.1% ）. Both gram-positive bacteria and gram-negative bacteria were high antibiotic resistant. Methicillin resistant Staphylococcus aureus accounted for 92.3% in Staphylococcus aureus, methicillin resistant Staphylococcus hemolyticus accounted for 100% in Staphylococcus hemolyticus. The drug resistance of Staphylococcus aureus to vancomycin was 2. 6 %. The drug resistance of gram-negative bacteria to the third-cephalosporin was very serious. Most Pseudomonas aeruginosa had significantly high drug resistance, with 15 strains resistant to all the antibiotic drugs. Conclusions The antibiotic resistance of HAP in senile patients in Guangzhou is significantly serious. Measures should be taken to prevent and cure it.