老年患者下呼吸道感染的病原菌分布及其耐药性分析

Distribution and Antibiotic Resistance of Pathogenic Bacteria of Lower Respiratory Tract Infections in Gerontal Patients

目的分析我院老年患者下呼吸道感染病原菌的分布及其耐药情况,为临床合理选用抗菌药物提供科学的依据。方法收集687例老年下呼吸道感染患者的痰液标本进行细菌培养,分离病原菌,用珠海迪尔试剂盒及分析软件进行细菌鉴定及药物敏感试验。结果 687例老年下呼吸道感染患者的痰液标本共检出病原菌241株,检出率为35.1%,其中革兰阴性杆菌165株,占68.5%;革兰阳性球菌35株,占14.5%;真菌41株,占17.0%。革兰阴性杆菌前3位分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌;革兰阳性球菌前3位是金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌。3种革兰阴性杆菌对亚胺培南的耐药率最低,对氨苄西林和左氧氟沙星的耐药率较高;葡萄球菌对青霉素的耐药率为100.0%,而对万古霉素、亚胺培南及替考拉宁均敏感。结论革兰阴性杆菌是老年患者下呼吸道感染的主要病原菌,最多的为肺炎克雷伯菌,应加强实验室对病原菌的耐药性监测,合理指导临床使用抗菌药,以减少耐药菌株的出现。

Objective To review the distribution and drug resistance of pathogens in nosocomial lower respiratory tract infections among 241 gerontal patients to provide reference for rational use of antimicrobial agents.Methods Sputum samples were collected from 687 hospitalized gerontal patients with lower respiratory tract infections.Pathogens were isolated from the sputum samples and bacterial rapid test kit and relevant software were applied to identify the types and antibiotic resistance of the pathogens.Results A total of 241 strains of pathogenic bacteria were isolated from the 687 patients（detection rate：35.1%）.Of these strains,165 were Gram-negative bacillus（68.5%）,35 were Gram-positive cocci（14.5%） and 41 were fungi（17.0%）.The top three Gram-negative bacilli were Klebsiella pneumonia,Escherichia coli,and Pseudomonas aeruginosa.The top three Gram-positive cocci were Staphylococcus aureus,Staphylococcus haemolyticus and Staphylococcus epidermidis.Analysis of drug resistance showed that imipenem resistance rates of the three Gram-negative bacteria were the lowest,while ampicillin and ofloxacin resistance rates were the highest.The resistance rate of staphylococcus to penicillium was 100%.Staphylococcus was sensitive to vancomycin,imipenem and teicoplanin.Conclusion Gram-negative bacteria are the main pathogens of lower respiratory tract infections among gerontal patients,with Klebsiella pneumonia most commonly seen.Pathogen detection and drug resistance monitoring should be enhanced with the hope to promote the rational use of antimicrobial agents and to slow down the emergence of antibiotic-resistant strains.