老年患者肺部感染革兰阴性菌临床分析

Clinical analysis of gram-negative bacteria causing pulmonary infections in senile patients

目的研究老年患者肺部感染革兰阴性菌临床分析及护理措施,为临床合理有效治疗提供依据。方法选取2009年1月-2012年6月收治的老年革兰阴性菌肺炎患者402例,收集患者的一般临床资料并采集患者痰液标本及下呼吸道分泌物进行菌株测定,并用K-B法对菌株进行药物敏感性研究。结果共检测出革兰阴性菌402株,其中铜绿假单胞菌172株占42.8%,肺炎克雷伯菌75株占18.6%,鲍氏不动杆菌43株占10.7%,大肠埃希菌37株占9.2%,阴沟肠杆菌24株占6.0%,流感嗜血菌23株占5.7%,其他革兰阴性菌28株占7.0%;主要革兰阴性菌对常用抗菌药物均产生了耐药性,铜绿假单胞菌、鲍氏不动杆菌甚至对碳青霉烯类抗菌药物产生了一定的耐药性,耐药率在10.5%～16.3%;402例患者中治愈379例,治愈率为94.2%,死亡18例,病死率为4.48%。结论老年患者肺部感染革兰阴性菌的耐药性呈逐年升高趋势,对该病的治疗应采取临床治疗加临床护理的综合防范和控制。

OBJECTIVE To explore the distribution of gram-negative bacteria causing pulmonary infections in senile patients and put forward nursing measures so as to provide guidance for reasonable clinical treatment.METHODS Totally 402 cases of senile patients with pneumonia caused by the gram-negative bacteria,who were treated in the hospital from Jan 2009 to Jun 2009,were enrolled in the study,then the general clinical data of the subjects were collected,the sputum specimens and the lower respiratory tract secretions were cultured for the identification of the strains,and the drug susceptibility testing was performed with the use of K-B method.RESULTS A total of 402 strains of gram-negative bacteria haven been isolated,among which there were 172（42.8%）strains of Pseudomonas aeruginosa,75（18.6%）strains of Klebsiella pneumoniae,43（10.7%）strains of Acinetobacter baumannii,37（9.2%）strains of Escherichia coli,24（6.0%）strains of Enterobacter cloacae,23（5.7%）strains of Haemophilus influenzae,and 28（7.0%）strains of other species of gram-negative bacteria.The main species of the gram-negative bacteria have produced drug resistance to the commonly used antibiotics;the drug resistance rates of the P.aeruginosaand A.baumannii to carbapenems varied between 10.5% and 16.3%.Of totally 402 patients,379 cases were cured with the cure rate of 94.2%,and 18cases died with the mortality of 4.48%. CONCLUSIONThe drug resistance rates of the gram-negative bacteria causing pulmonary infections in the senile patients are increased year by year,thus the comprehensive prevention and control measure,the clinical treatment combined with clinical nursing,should be taken for the treatment of the disease.