高龄院内获得性肺炎病原学分布及药敏分析

Pathogenic distribution and drug sensitivity analysis in very old patients with hospital-acquired pneumonia

目的探讨高龄老年院内获得性肺炎（HAP）患者的危险因素和病原学分布特点及药敏分析。方法选择2006年1月-2012年4月解放军第161医院干部病房收治的老年HAP患者206例，回顾性分析其临床资料及痰培养结果。采用K—B法进行细菌药敏试验。按CLSI2009版判断结果。结果所有患者均存在基础疾病及多种高危因素，2011年1月1日-2012年4月25日共分离出215株致病菌，其中革兰阴性杆菌占61．55％，革兰阳性菌占26．63％，真菌占2．43％。大部分革兰阴性菌对亚胺培南、美罗培南敏感，革兰阳性球菌对利奈唑胺敏感。结论对于高龄HAP患者应积极控制危险因素，重视病原学检查，根据药敏结果针对性治疗，有助于达到较好的治疗效果，减少耐药菌株产生。

Objective To discuss the risk factors and pathogenic distribution of hospital-acquired pneumonia（HAP） in elderly patients and to perform the drug sensitivity analysis. Methods A total of 206 HAP patients were included from January 2006 to April 2012 in Chinese PLA 161st Hospital. Their clinical data and sputum culture results were analyzed retrospectively. Susceptibility test was carried out by Kirby-Bauer method according to CLSI2009. Results All 206 subjects suffered from multiple basic diseases and presented with many risk factors. Totally 215 strains were isolated, including gram negative bacteria（61.55%）, gram positive cocci（26.63%） and Fungi（2.43%）, respectively. Most bacilli were susceptible to imipenem and meropenem, and gram positive cocci to vancomycin and linezolid. Conclusions For elderly HAP patients, control of risk factors, detection of pathogens and use of antibiotics according to drug susceptibility will help to acquire satisfactory therapeutic effect and reduce the drug resistant strains.