老年截瘫患者医院获得性肺炎病原菌及耐药性分析

Analysis of pathogenic bacteria and their drug resistance of hospital-acquired pneumonia in elderly paraPlegic patients

目的了解本地区老年截瘫患者医院获得性肺炎（HAP）的病原菌分布及抗菌药物的耐药性，有利于早期经验性使用抗菌药物。方法选择本院2007年1月至2010年12月期间符合HAP的老年截瘫患者136例，进行病原菌分布及药物耐药性监测。结果136例患者共分离出152株病原菌，其中以革兰阴性杆菌占优势，占总数的70．4％；病原菌分布前3位依次为肺炎克雷伯菌（24．3％）、大肠埃希氏菌（20．4％）和铜绿假单胞菌（18．4％）；革兰阳性球菌占病原菌总数的25．0％，以金黄色葡萄球菌及肺炎链球菌最多见，真菌数量较少。革兰阴性菌的耐药率要高于革兰阳性菌；其中革兰阴性菌对氨苄西林、头孢哌酮、环丙沙星、左氧氟沙星和复方新诺明等药物耐药性较高，革兰阳性菌对青霉素、头孢唑林、庆大霉素耐药性较高。结论老年截瘫HAP患者主要致病菌群为革兰阴性菌，且呈现出多重耐药性，掌握其病原菌及耐药性特点，可以为老年截瘫患者HAP的早期治疗和改善预后提供更好的保障。

Objective To investigate pathogens distribution and their drug resistance of hospital acquired pneumonia （HAP） in local elderly paraplegic patients, and to help to gain experience in early using antibiotics. Methods One hundred and thirty six elderly patients diagnosed as HAP from January 2007 to December 2010 in our hospital were selected. Pathogens distribution and their drug resistance were detected. Results One hundred and fifty two pathogens are isolated from the 136 patients, and most of them are gram negative bacteria which accounts for 70. 4%. The first three pathogens are Klebsiella pneumonia（24. 3% ）, Escherichia coli（20. 4% ） and Pseudomonas Aeruginosa（ 18. 4% ）. Gram-positive cocci accounts for 25. 0% in total pathogens, among them, staphylococcus aureus and streptococcus pneumoniae account for the most, and the number of Fungi is the fewest. Drug resistance rate of gram-negative bacteria is higher than that of Gram-positive bacteria. Gram-negative bacteria has higher resistance to ampicillin, cefoperazone, ciprofloxacin, levofloxacin and cotrimoxazole. Gram-positive bacteria has higher resistance to penicillin, cefazolin and gentamicin. Conclusion To elderly paraplegic HAP patients, the main pathogenic flora is gram-negative bacterium which shows multiple resistances. Being familiar with the features of pathogens and their drug resistance will provide better guidance on early treatment and improve prognosis of elderly paraplegic HAP patients.