老年肺炎患者病原菌的分布及耐药性

Distribution and Drug Resistance of Pathogens in Senile Patients with Pneumonia

目的探讨老年肺炎患者病原菌的分布及耐药状况,为临床合理使用抗菌药物提供帮助。方法对407例老年肺炎患者的痰标本,进行细菌培养鉴定及药物敏感试验,并对结果进行分析。结果共分离出病原菌291株,革兰阴性杆菌202株(69.4%),主要分离菌依次为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、嗜麦芽假单胞菌、鲍氏不动杆菌等;革兰阳性球菌60株(20.6%),以金黄色葡萄球菌为主,占12.7%;MRSA占所分离金黄色葡萄球菌约72.8%;真菌29株(10.0%),以白色假丝酵母菌为主,占7.56%;药物敏感试验显示,所分离的病原菌对抗菌药物存在多药耐药性,不同病原菌对各种抗菌药物的耐药率差异较大;革兰阴性杆菌对氨苄西林耐药率最高,耐药率接近100.0%,对碳青酶烯类药物亚胺培南的耐药率最低,耐药率0～14.3%,肺炎克雷伯菌及大肠埃希菌ESBLs阳性率分别为56.5%和41.2%。结论老年肺炎患者的主要病原菌为革兰阴性杆菌,病原菌对抗菌药物存在多药耐药性;临床应根据药敏试验结果选择抗菌药物。

[Objective] To study the distribution and drug resistance of pathogens in senile patients with pneumonia, provide the help for the rational use of antibiotics in clinic.[Methods]The bacterial culture and identification, drug sensitivity test were conducted in the sputum specimens of 407 senile patients with pneumonia, and the results were analyzed.[Results]291 pathogenic bacteria were isolated. There were 202 （69.4%） strains of Gram-negative bacilli, and the main isolated bacteria were in sequence of Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Pseudomonas maltophilia and Acinetobacter baumannii. There were 60 （20.6%） strains of Gram-positive bacteria, which dominated by Staphylococcus aureus （12.7%）. MRSA accounted for 72.8% of isolated Staphylococcus aureus. There were 29 （10.0%） strains of fungi, which dominated by Candida albicans （7.56%）. The drug sensitivity test showed that the isolated pathogenic bacteria had multi-drug resistance to antibiotics, and there was great difference in resistances among different pathogenic bacteria. The resistance rate of Gram-negative bacilli to ampicillin was the highest, which was nearly 100.0%, and resistance rate to imipenem was the lowest （0~14.3%）. The positive rate of Lactamases （ESBLs） in Klebsiella pneumoniae and Escherichia coli was 56.5% and 41.2%, respectively.[Conclusion]The main pathogens of senile patients with pneumonia were Gram-negative bacilli, and pathogenic bacteria had multidrug resistance to antibiotics. The antibiotics should be chosen according to the results of drug sensitivity test.