高龄患者医院获得性肺炎的病原菌构成及耐药性分析

Analysis of pathogenic bacteria and its drug resistance of hospital acquired pneumonia for elderly patients

目的探讨高龄患者医院获得性肺炎(HAP)常见病原菌构成及其耐药情况。方法对2011年1月～2012年4月本院综合病房收治的198例高龄HAP患者痰标本中分离出的病原菌进行细菌鉴定,采用Kirby-Bauer法检测其耐药性。结果分离出病原菌共308株,革兰阴性细菌187株(60.71%),革兰阳性细菌94株(30.52%),其中MRSA 34株,占所分离金黄色葡萄球菌的73.91%,真菌27株(8.77%)。前4种病原菌分别为铜绿假单胞菌(21.75%)、金黄色葡萄球菌(14.94%)、大肠埃希氏菌(12.66%)和肺炎克雷伯菌(11.04%),且普遍呈现多重耐药。结论高龄患者HAP病原菌以革兰阴性菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)及条件致病菌的分离率及耐药率有增加趋势,建立细菌耐药预警机制,早期、规范使用抗生素意义重大。

Objective To investigate the pathogenic bacteria and its drug resistance of hospital acquired pneumonia for el- derly patients. Methods A retrospective study was conducted on elderly patients in our hospital from Jan. 2011 to Apr. 2012. Total 198 patients were enrolled in this study, whose sputum specimens were identified and detected the drug resistance by Kirby-Bauer disk diffusion susceptibility test. Results Three hundred and eight strains pathogenic bacteria were separated from sputum specimens of HAP for elderly patients. The proportion of Gram-negative bacterium（G-）, Gram-positive bacterium（G＋） and eumycete was 60.71%, 30.52% and 8.77%. Thirty four strains methicillin-resistant Staphylococcus aureus （MRSA） were separated,accounting for the separation of 73.91% of Staphylococcus aureus. The most common pathogenic bacterias were Pseudomonas aeruginosa （21.75%）, Staphylococcus aureus（14.94%）, Escherichia coli（12.66%） and Klebsiella pneumoniae （11.04%）. These bacterias were resistant to most common antibacterials. Conclusion The pathogenic bacteria of HAP for elderly patients are G-. The separation and resistance rate of MRSA and the opportunistic pathogen is increasing. It is important to establish early warning mechanism of bacterial drug resistance and regulate the use of antibiotics.