老年医院获得性肺炎的病原菌构成与耐药性调查

Investigation of distribution and drug resistance of pathogenic bacteria causing hospital-acquired pneumonia in senile patients

目的调查分析老年医院获得性肺炎的病原菌构成及对抗菌药物的耐药性,为临床预防感染及合理用药提供参考依据。方法标本采集、细菌培养、菌种鉴定按照卫生部《全国临床检验操作规程》(第3版)进行;药物监测试验操作、结果评价、质量控制采用CLSI推荐的K-B法进行,数据处理采用WHONET5.4软件分析。结果 277例老年肺炎患者痰液中分离出292株病原菌,革兰阴性杆菌占68.8%、革兰阳性球菌占23.3%、真菌占7.9%;排前5名的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、鲍氏不动杆菌,分别占25.0%、20.2%、19.2%、9.6%、9.2%,以上病原菌对临床抗菌药物均产生了不同程度的耐药性;对革兰阴性菌最敏感的药物有阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌啦西林/他唑巴坦等,敏感率100.0%～74.1%;对革兰阳性菌最敏感的药物有万古霉素、替考拉宁,敏感率为100.0%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为10.2%和14.8%;产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌检出率为45.5%;耐甲氧西林葡萄球菌检出率达41.1%。结论老年医院获得性肺炎感染病原菌的耐药性逐年加重,应采取综合性治理措施,减缓细菌耐药性的增长速度。

OBJECTIVE To investigate constituent ratio and drug resistance of pathogenic bacteria causing hospitalacquired pneumonia in senile patients and provide the scientific evidence for the clinical prevention of infection and use of antibiotics.METHODS Referring to National Guide to Clinical Laboratory Procedures（3rd Ediction）,specimen collection,bacterial culture and identification were performed.The antibiotic susceptibility testing,results assessment and quality control were performed by K-B method recommended by CLSI.The WHONET 5.4 software was used to process the data.RESULTS Totally 292 strains pathogenic bacteria isolated from sputum of the 277 elderly patients with pneumonia included the gram-negative bacilli（68.8%）,gram-positive cocci（23.3%）and fungi（7.9%）.The Klebsiella pneunmoniae（25.0%）,Pseudomonas aeruginosa（20.2%）,Staphyloccocus aureus（19.2%）,Escherichia coli（9.6%）and Acinetobacter baumannii（9.2%）ranked the top five species of pathogens,all the strains above were resistant to the commonly used antibiotics in different degree.The most sensitive drugs against the gram-negative bacteria included amikacin,imipenem,meropenem,cefoperazone/sulbactam,and piperazine/tazobactam,with the drug susceptibility rate varying between 100.0% and 74.1%;the most sensitive drugs against the gram-positive bacteria included vancomycin and teicoplanin,with the drug susceptibility rate of 100.0%;the detection rates of the imipenem-resistant P.aeruginosaand A.baumannii were 10.2% and 14.8%,respectively;the isolation rate of the extended spectrumβ-lactamase（ESBLs）-producing Enterobacteriaceae was 45.5%;the isolation rate of the methicillin-resistant Staphylococci was 41.1%.CONCLUSION The drug resistance of the pathogens causing the hospital-acquired pneumonia in the senile patients increases year by year,it is necessary to take comprehensive treatment measures to postpone the increasing trend of bacterial resistance.