老年患者医院感染常见病原菌的种类及耐药性探讨

Species of common pathogens causing nosocomial infections in senile patients and analysis of drug resistance

目的探讨老年患者并发医院感染的临床现状、病原菌种类及耐药程度,为预防治疗医院感染提供参考依据。方法回顾性调查2008年1月-2011年12月收治的≥60岁老年住院患者临床资料;细菌培养及鉴定依据卫生部临床检验中心制定的《全国临床检验操作规程》进行试验操作;药敏试验结果判断依据CLSI指定的K-B法及折点;试验过程进行全程质量控制。结果 2037例老年患者医院感染率为9.6%,例次感染率11.6%;感染部位以下呼吸道最多,占55.5%,其次是泌尿道占24.6%,第3位是皮肤黏膜感染占7.9%;感染病原菌中革兰阴性杆菌分离率最高占70.9%,革兰阳性球菌占16.4%,真菌占12.7%;肠杆菌科细菌对碳青霉烯类抗菌药物、革兰阳性球菌对糖肽类抗菌药物敏感率达100.0%,但大多数病原菌对其他常用抗菌药物产生了较为严重的耐药性,而且耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为11.3%和17.6%,MRSA、MRCNS、产ESBLs细菌检出率分别为42.2%、40.4%、45.4%。结论老年患者是医院感染的高发群体,其感染病原菌的抗药性越来越严重,医院应采取行之有效的干预对策,积极预防与控制老年患者医院感染。

OBJECTIVE To explore the clinical status of nosocomial infections caused by different species of pathogens in the senile patients and analyze the drug resistance so as to provide basis for the prevention and treatment of nosocomial infections.METHODS The clinical data of the hospitalized patients aged more than 60 years who were treated in the hospital from Jan 2008to Dec 2011were retrospectively analyzed.The bacterial culture and identification were performed according to National Guide to Clinical Laboratory Procedure.The drug susceptibility testing was carried out,and the results were assessed by K-B methods recommended by CLSI.The quality control was performed throughout the experiment.RESULTS Of 2037cases of senile patients investigated,the incidence rate of nosocomial infections was 9.6%,and the case-time infection rate was 11.6%.The most common site was the lower respiratory tract（55.5%）,followed by the urinary tract（24.6%）,skin and mucous membrane（7.9%）and so on.Of the pathogens causing the infections,the gram-negative bacilli accounted for 70.9%,followed by the gram-positive cocci（16.4%）and fungi（12.7%）.The susceptibility monitoring results showed that except for 100.0% of sensitivity of carbapenem antibiotics against Enterobacteriaceae and glycopeptide antibiotics against gram-positive cocci,most of the pathogenic bacteria were more severely resistant to other commonly used antibiotics.The isolating rates of imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were 11.3%and 17.6%,respectively,and the detection rates of the methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus（MRCNS）were 42.2% and 40.0%,respectively.The isolating rate of ESBLs-producing strains was 45.4%.CONCLUSION The senile patients are the population at high risk of nosocomial infections,the drug resistance of the pathogens causing infections becomes increasingly serious.The hospital should take effective intervention measures so as to prevent and control the nosocomial infections in the senile patients.