老年患者革兰阴性杆菌肺炎的病原菌分布及耐药性分析

Distribution and drug resistance of gram-negative bacilli pneumonia among senile patients

目的探讨老年患者革兰阴性杆菌性肺炎的病原菌分布及耐药性,为临床合理选择抗菌药物提供依据,并制定预防与控制措施。方法对324例老年革兰阴性杆菌性肺炎患者的痰及下呼吸道分泌物进行常规细菌培养,用琼脂扩散法进行体外药敏试验并统计分析。结果铜绿假单胞菌检出率占首位为26.2%,肺炎克雷伯菌、大肠埃希菌产超广谱β-内酰胺酶(ESBLs)检出率分别为34.1%、29.4%;除流感嗜血菌对常用抗菌药物保持较好的敏感外,其他病原菌对常用抗菌药物的耐药性普遍升高,产ESBLs肠杆菌科细菌检出率达31.1%。结论老年患者肺炎以革兰阴性菌为主,病原菌多药耐药现象严重,做好病原菌的培养和药敏试验非常必要,为临床医师合理用药提供科学依据。

OBJECTIVE To investigate the etiology and drug resistance status of gram-negative bacilli pneumonia among senile patients and to provide the basis for the rational use of antibiotics and the preventive and control measures.METHODS The secretions from sputum and lower respiratory tract of 324 senile patients with gram-negative bacilli pneumonia were collected for routine bacterial culture,the agar disc diffusion test was adopted to perform in vitro drug susceptibility testing.RESULTS Pseudomonas aeruginosa rated the top one,reaching to 26.2%,followed by ESBLs-producing Klebsiella pneumoniae（34.1%） and Escherichia coli（29.4%）;the drug resistance of gram-negative bacilli to common antibacterials were rising except that Haemophilus influenzae was susceptible to common antibiotics,the detection rate of extended-spectrum beta-lactamases（ESBLs）-producing Enterobacteriaceae reached to 31.1%.CONCLUSION The main pathogens causing bacterial pneumonia among senile patients are gram-negative bacteria which present serious multidrug-resistance;it is very necessary to perform the bacterial culture and the drug susceptibility testing which can provide scientific reference for the rational use of antibiotics.