老年患者医院获得性肺炎的病原菌及耐药性探讨

Distribution and drug resistance of pathogens causing hospital-acquired pneumonia in elderly patients

目的调查鄂西山区医院老年患者医院获得性肺炎的病原菌分布及耐药性,为内科病区预防、控制医院获得性肺炎及合理使用抗菌药物提供参考依据。方法根据卫生部制定的《医院感染诊断标准》筛选年龄≥60岁的医院获得性肺炎患者,感染病原菌培养鉴定按照《全国临床检验操作规程》进行;药敏试验采用CLSI推荐的K-B法和最新规则进行操作与评价;采用WHONET 5.4-5.5版本分析数据。结果共分离247株病原菌,分离率居前6位的病原菌依次为铜绿假单胞菌占25.9%、肺炎克雷伯菌占16.6%、金黄色葡萄球菌占15.0%、鲍氏不动杆菌占14.6%、白色假丝酵母菌占8.1%、大肠埃希菌占7.3%;主要病原菌对常用抗菌药物均产生了较为严重的耐药性,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌分别达10.9%、13.9%;产ESBLs大肠埃希菌和肺炎克雷伯菌检出率为40.7%;耐甲氧西林金黄色葡萄球菌检出率为48.6%;但肠杆菌科细菌对碳青霉烯类抗菌药物100.0%敏感;革兰阳性球菌对糖肽类抗菌药物100.0%敏感。结论鄂西山区老年医院获得性肺炎的病原菌耐药性呈上升趋势,应采取干预措施,延缓和控制细菌耐药率快速增长的不利局面。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing hospital- acquired pneumonia in senile patients so as to provide reference for the prevention and control of the hospital- acquired pneumonia in the internal medicine department and for the reasonable use of antibiotics. METHODS Referring to Diagnosis Standard of Nosocomial infections by Ministry of Public Health, the patients with hospital-acquired pneumonia over sixty years old were enrolled in this study. According to National Guide to Clinical Laboratory Procedures, the strains were cultured and identified. The antibiotic susceptibility testing was performed by K-B methods recommended by CLSI. The testing results were assessed. The WHONET 5.4-5.5 software was used to analyze the data. RESULTS Among 247 strains of pathogenic bacteria isolated, the Pseudomonas aeruginosa （25. 9%）, Klebsiella pneunmoniae （ 16. 6%）, Staphylococcus aureus （15. 0%）, Acinetobacter baumannii （14.6 %）, Candida albicans （8. 1%） and Escherichia coli （7. 3 %） ranked the top six species. The main pathogens were highly resistant to the commonly used antibiotics; the imipenem-resistant P. aeruginosa and A. baumannii accounted for 10. 9% and 13. 9%, respectively. The isolation rates of the ESBLs-producing E. coli and K. pneunmoniae arrived at 40. 7% , the methicillin-resistant S. aureus （MRSA） 48.6%. The Enterobacteriaceae isolates were 100.0% sensitive to the carbapenems. And the gram-positive cocci were 100.0% sensitive to glyeopeptides antibiotics. CONCLUSION The drug resistance of the pathogens causing hospital-acquired pneumonia in senile patients is on the rise in Western Mountain Area of Hubei Province. The comprehensive interventions should be adopted to control the rapid increase in the bacterial resistance.