老年糖尿病患者败血症的临床和病原学特点

Clinical and pathogenic features of septisis in senile diatectic patients

目的研究老年糖尿病患者败血症的临床和病原菌特点。方法对2004年1月-2008年12月住院的87例老年糖尿病合并败血症患者的临床资料进行回顾性分析。结果共分离出108株病原菌；其中革兰阴性菌58株（53．7％），革兰阳性菌35株（32．4％），真菌15株（13．9％）。致病菌入侵途径分别为呼吸道、泌尿系、胃肠道、胆系、破损皮肤、深静脉导管。常见的病原菌为大肠埃希菌（21.3％）、凝固酶阴性葡萄球菌（18．5％）、肺炎克雷伯菌（12．0％）、白色念珠菌（7．4％）、鲍氏不动杆菌（5．6％）。大肠埃希菌、肺炎克雷伯菌ESBLs检出率分别为47．8％和23．1％；耐甲氧西林凝固酶阴性葡萄球菌（MRCNs）的检出率为100％。耐甲氧西林葡萄球菌（MRSA）和MRCNS表现为高度的耐药性，但未发现对万古霉素和替考拉宁耐药菌株。结论老年糖尿病合并败血症常见，肠杆菌科细菌、葡萄球菌属和真菌是主要病原菌。尽早行血培养，开展病原菌耐药性监测，对指导临床合理使用抗菌药物和控制感染十分重要。

Objective To survey the clinical characteristic and pathogen distribution of senile septicemia patients with diabetes. Methods Eighty seven senile diabetic patients with septicemia from January 2004 to December 2008 were surveyed. Results Among 108 strains of isolated pathogens,gram-negative organisms accounted for 53.70% of isolates, while gram-positive organisms was 32.4% and fungi 13.9% .The invasive pathways of septicemia were respiratory system , urine system , gastrointestinal tract,biliary tract,damaged skin and intravenous catheter detain .The commonest pathogens ausing septicemia were E.coli（ 21.3% ） , Coagulase negative staphylococcus （18.5%）, KlebsieUa pneumoniae （12.0%）, Candida albicans （7.4%）,Acinetobacter baumannii （5.6%）.The ESBLs isolating rate was 47.8% in E.coli and 23.1% in Klebsiella pneumoniae.The isolating rate of methicillin-resistant Coagulase negative staphylococcus（MRCNS） was 100.0%. Methicillinresistant Staphylococcus aureus （MRSA） and MRCNS were highly resistant to the commonly used antibiotics,but all susceptible to vancomycin and teicoplanin. Conclusion Septicemia in senile diabetic patients is very common . Early isolation of pathogens and monitoring of resistance of bacteria to antibiotics is very important for rational use of antibiotics and infection control.