老年下呼吸道感染患者病原菌种类与药敏分析

Pathogen Distribution and Resistance Analysis in Lower Respiratory Tract Infections of Senile Patients

目的了解老年下呼吸道感染患者痰培养阳性标本的病原菌种类和耐药性情况。方法回顾性分析2006年1月1日~2009年6月30日医院老年内科及呼吸内科住院的〉65岁下呼吸道感染患者449份痰培养阳性标本的病原菌种类和药敏结果。结果临床分离病原菌690株,以革兰阴性杆菌为主,占56.2%,革兰阳性球菌占26.3%,真菌占17.5%;下呼吸道感染的主要病原菌前10位依次为：金黄色葡萄球菌（14.9%）,白色假丝酵母菌（13.9%）,铜绿假单胞菌（13.0%）,鲍氏不动杆菌（10.9%）,肺炎克雷伯菌（8.3%）,大肠埃希菌（6.4%）,阴沟肠杆菌（4.3%）,溶血葡萄球菌（3.2%）,嗜麦芽寡养单胞菌（3.2%）及副流感嗜血菌（2.3%）;耐甲氧西林金黄色葡萄球菌（MRSA）比例高,占68.0%;未发现耐万古霉素金黄色葡萄球菌;铜绿假单胞菌和鲍氏不动杆菌对多种抗菌药物耐药;肺炎克雷伯菌和大肠埃希菌对亚胺培南、头孢哌酮/舒巴坦等敏感性仍较高。结论老年患者下呼吸道感染病原菌以革兰阴性杆菌为主,耐药菌株比例高,同时应注意真菌感染,治疗中应根据药敏结果合理选用抗菌药物。

OBJECTIVE To investigate the pathogen distribution and resistance in lower respiratory tract infections of senile patients′ positive clinical sputum specimens.METHODS The pathogen distribution and resistance of 449 senile patients′ sputum samples were analyzed retrospectively who were older than 65 years old and with lower respiratory tract infection from Jan 2006 to Jun 2009 in Peking University the Third Hospital.RESULTS Totally 690 clinical isolates were collected,including Gram-negative bacilli（56.2%）,Gram-positive cocci（26.3%） and fungi（17.5%）.The pathogens of the 10 highest isolating rate were Staphylococcus aureus（14.9%）,Candida albicans（13.9%）,Pseudomonas aeruginosa（13.0%）,Acinetobacter baumannii（10.9%）,Klebsiella pneumoniae（8.3%）,Escherichia coli（6.4%）,Enterobacter cloacae（4.3%）,S.haemolyticus（3.2%）,Stenotrophomonas maltophilia（3.2%）and Haemophilus parainfluenzae（2.3%）.In view of the resistance,the main proportion of S.aureus was MRSA（68.0%）;no S.aureus were resistant to vancomycin;P.aeruginosa and A.baumannii were resistant to the most antimicrobial agents;K.pneumoniae and E.coli were sensitive to meropenem,imipenem and cefoperazone/sulbactam.CONCLUSIONS Gram-negative bacilli are the main pathogens of senile patients with lower respiratory tract infections.The pathogens have a high resistance rate to many antimicrobial agents.The proportion of fungal infectons is higher in senile patients with lower respiratory tract infections.Antibiotics should be chosen according to resistance analysis.