老年患者下呼吸道感染病原体构成及耐药性分析

Clinical analysis of distribution and resistance of pathogenic bacteria in senile patients of lower respiratory tract infection

目的:对老年患者下呼吸道感染细菌构成和耐药性进行分析,为临床合理使用抗生素提供依据。方法:采集我院老年下呼吸道感染患者的痰标本,采用K-B法进行药敏试验,按CLSI 2009年版标准判断结果。结果:633例分离菌株中,革兰阴性杆菌、革兰阳性球菌和真菌分别占68.25%、21.32%和10.4%。前5位菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌(金葡菌)和鲍氏不动杆菌。甲氧西林耐药金葡菌占金葡菌的75.7%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。革兰阴性菌对碳青霉烯类耐药率低于35%,对氨苄西林和三代头孢菌素耐药率均在84%以上。铜绿假单胞菌和鲍氏不动杆菌对多种抗生素高比例耐药(14.7%～96.0%),鲍氏不动杆菌对碳青霉烯类、头孢哌酮/舒巴坦和阿米卡星敏感,肺炎克雷伯菌和大肠埃希菌耐药谱相近。结论:老年患者下呼吸道感染细菌分布较广泛,且耐药现象严重;应加大细菌监测,合理使用抗生素,以减缓耐药性产生。

Objective： To analysis distribution and resistance of Pathogenic Bacteria in senile patients from lower respiratory tract infection and provide reference for rational use of antibiotics in clinics.Methods： Phlegm specimens were collected from lower respiratory tract in elder patients from January 2007 to December 2011 in our institution.K-B test was used to determine drug susceptibility and the results were read based on 2009 Clinical and Laboratory Standards Institute（CLSI）.Results： Among 633 isolated strains,gram-negative bacteria,gram-positive cocci and fungi were 68.25%,21.32% and 10.4%,respectively.The top 5 of isolated bacteria were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii.MRSA accounted for 75.7% of Staphylococcus aureus and resistant gram-positive cocii to Vancomycin,Teicoplanin and Linezolid were not found.The resistant rate of gram-negative bacteria was less than 35% to carbapenems,and more than 84% to Ampicillin and third generation Cephalosporins.Pseudomonas aeruginisa and Acinetobacter baumannii had higher resistant rate to many antibiotics,their resistant rate were 14.7%-96.0%.Acinetobacter was more susceptible to carbapenems,cefoperazone / sulbactam and amikacin.The drug-resistant spectrum of Klebsiella pneumoniae and Escherichia coli was similar.Conclusion： The bacteria from lower respiratory tract infection in elderly patients were distributed extensively and there was severe resistance to antimicrobials.It is necessary to monitor bacteria,using rationally antibiotics and curbing down their drug-resistence.