老年人MRSA院内肺部感染的相关危险因素和耐药性研究

The research on the related risk factors and resistance of nosocomial pulmonary infection in the elderly patients with MRSA

目的了解老年人耐甲氧西林金黄色葡萄球菌(MRSA)院内肺部感染的临床特点、相关危险因素及细菌耐药性。方法对75例老年人院内肺部感染的临床资料进行统计分析,用纸片法检测金黄色葡萄球菌对甲氧西林等20种抗生素的体外药敏试验。结果 75例患者MRSA医院肺部感染均有基础疾病和诱发因素,有基础疾病61例(81.3%);遭受严重创伤或经历重大手术者24例(32.0%)。临床症状以发热、咳嗽、咳痰为主,胸部X线示有大片状阴影者23例(30.7%),小片浸润者41例(54.7%),有空洞、液气囊腔11例(14.7%)。全组有胸腔积液10(13.3%)。75例MRSA对20种抗菌药物的药敏结果显示对万古霉素、利奈唑胺敏感,对呋喃妥因、氯霉素、复方新诺明、利福平敏感性较好。结论老年人MRSA医院肺部感染者多有基础疾病、多重耐药、病死率高,,临床应予高度重视。

Objective To investigate the clinical characteristics, related risk factors and resistance of nosocomial pulmonary infection in the elderly patients with Methicillin resistant Staphylococcus anreus. Methods A statistical analysis was made on the clinical data of 75 elderly patients with nosocomial pulmonary infection of Methicillin resistant Staphylococcus anreus. Paper disk method was used in drug sensitivity test in vitro of staphylococcus anrcus infection with 20 antibiotics including methicillin. Results The 75 elderly patients with nosocomial pulmonary infection of MRSA had underlying diseases and inducing factors. 61 cases had underlying diseases（ 81.3% ） ; 24 cases suffered from serious injury or experienced a great operation（ 32.0% ）. Clinical manifestations included fever, cough and expectoration. 23 cases （30. 7 % ） had big piece shadow chest X_ray revealed infiltration; 41 cases （54. 7 % ） shadows are blured to small form; 11 cases （14.7 % ） had cavity and liquid-gas cyst cavity; 10 cases （13.3 % ） had pleural effusion. Drug sensitivity results of M RSA with 20 antibiotics showed that MRSA was sensitive to vancomycin and linais; Sensitivity to nitrofurantoin, ehloramphenicol, Sinomin and rifampicin were 89.3% ,69.3% ,66.7% , and 58.7% , respectively; tetracycline, levofloxaein, gentamicin, ciprofloxacin, elindamycin erythromyein and imipenem were 25.3%, 12.0%, 10.7%, 10.7%, 9. 3%, 4. 0% and 0, respectively, which were highly resistant or pan-resistant to MRSA. Conclusions The 75 elderly patients with nosocomial pulmonary infection of MRSA have underlying diseases, multidrug resistance to antibiotics and high mortality, which is necessary to pay high attention in clinic.