老年人咽部黏膜微生物种群检测分析

A survey and analysis of oropharyngeal microbial colonization in elderly patients

目的 对618例老年人口咽部微生物种群定植情况进行分析. 方法 采用咽拭子培养法分组调查了618例老年人和96例中青年人口咽部黏膜细菌和真菌定植情况. 结果 中青年组85.4％（82例）以草绿色链球菌和奈瑟氏球菌2种细菌组合为主,构成模式简单.老年组每份标本分离细菌多为3～5种,仅25.7％（159例）共生菌构成模式为草绿色链球菌和奈瑟式球菌,表现出生物多样性.老年组革兰阴性杆菌分离率高于中青年组,分别为53.1％（328/618）和6.3％（6/96）,老年组革兰阳性菌定植以金黄色葡萄球菌和肺炎链球菌为主.老年组假丝酵母真菌的定植率为9.1％（56/618）. 结论 共生菌减少特别是草绿色链球菌减少可能是老年人口咽部黏膜菌群模式改变和机会致病菌定植的病理基础；老年人口咽部黏膜革兰阴性杆菌定植率增加,肺炎克雷伯菌为常见菌.肠杆菌科细菌和铜绿假单胞菌及鲍曼不动杆菌对常用抗生素表现敏感.

Objective To investigate the oropharyngeal microbial colonization in elderly patients.Methods Totally 618 elderly cases and 96 young and middle-aged cases were involved in this investigation.The colonization of bacteria and fungi on the oropharyngeal mucosa were obtained by throat swab cultures.Results There were 85.4% of cases （82 cases） with Streptococcus viridans and Neisseria gonorrheae on the oropharynx mucosa in young and middle-aged group and the pattern of constitute was simple.3 to 5 bacterial species were isolated from the oropharyngeal mucosa in elderly group.There were only 25.7% of cases （159 cases）with Streptococcus viridans and Neisseria gonorrheae on the oropharyngeal mucosa in elderly group.Biodiversity of the constitution pattern in the bacterial colonization was exhibited in the elderly.The colonization rate of Gramnegative bacilli was higher in elderly group than in young and middle-aged group [53.1% （328/618）vs.6.3% （6/96）].Staphylococcus aureus and Streptococcus pneumonia were the common Grampositive bacteria colonization in the elderly.The colonization rate of Candida fungus was 9.1 % （56/618） in the elderly.Conclusions The reduction of commensal bacteria,especially Streptococcus viridans may be the pathological basis of mode changes in bacteria colonization and opportunistic bacteria colonization on oropharyngeal mucosa in the elderly.The colonization rate of oropharyngeal Gram-negative bacili is obviously increased and Klebsiella Pneumoniae is the common bacteria on oropharyngeal mucosa in the elderly.Enterobacteriaceae,Pseudomonas aeruginosa and Acinetobacter baumannii are sensitive to common antibiotics.