下呼吸道感染的老年患者病原菌及耐药观察

Pathogens and Drug Resistance Observed in Elderly Patients with Lower Respiratory Tract Infections

目的对下呼吸道感染的老年患者的致病细菌分布及耐药性进行监测分析,为临床用药提供客观的依据。方法收集2010年1月-2012年1月老年下呼吸道感染患者的痰液,进行菌株鉴定和药敏试验,观察分析近两年常见致病菌株及敏感药物。结果①革兰阳性球菌为229株,占17.9%;革兰阴性杆菌为894株,占69.9%。检出肺炎克雷伯菌共计196株,占15.3%;大肠埃希菌为167株,占13.1%;金黄色葡萄球菌152株,占11.9%;铜绿假单胞菌为186株,占14.5%。真菌为162株,占12.7%。②常见革兰氏阴性杆菌对头孢唑林、氨苄西林等药物均产生较为严重的耐药性,对亚胺培南耐药率最低;金葡球菌对万古霉素最为敏感,对其他药物均有不同程度耐药。结论临床治疗下呼吸道感染的老年患者,首先考虑抗革兰阴性杆菌敏感的药物,若痰培养等提示为革兰阳性菌,首选万古霉素药物。

Objective To provide an objective basis for clinical medication by monitoring and analyzing the distribution of path- ogenic bacteria and drug resistance in elderly patients with lower respiratory tract infections in our hospital. Methods Sputum from elderly patients with lower respiratory tract infections in our surgical treatment from January 2010 to January 2012 was col- lected. Through strain identification and susceptibility testing,the common pathogenic bacteria strains and sensitive drugs of last two years were observed and analyzed. Results （~）There was 229 strains of Gram-positive cocci, accounting for 17.9% ;894 strains of Gram-negative bacilli ,accounted for 69.9%. A total of 196 strains of Klebsiella pneumoniae were detected, accounted for 15.4% ;167 strains of Escheriehia coli for 13.1% ; 152 strains of Staphylococcus aureus lactis for 11.9% ;P186 strains of seudomonas aeruginosa for 14.6% ; 162 strains of Fungi for 12.6%. ~）Common gram-negative bacilli more serious resistance to cefazolin,ampicillin and other drugs;The lowest resistance rate was to imipenem;Staphylococcus aureus is the most sensitive to vancomyein, no apparent resistance, other drugs have varying degrees of resistance. Conclusion In the clinical treatment of lower respiratory tract infections in elderly patients, the drugs which were sensitive to the anti-Gram-negative bacilli should be first con- sidered;if sputum cultures perform gram-positive bacterias, the preferred vaneomycin drugs should firstly be considered.