老年患者医院获得性肺炎的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing hospital-acquired pneumonia in elderly patients

目的调查老年患者医院获得性肺炎的病原菌分布及其对常用抗菌药物的耐药性,为医师正确诊断疾病及针对性用药提供实验室参考依据。方法调查2010年1月-2012年12月≥60岁的224例医院获得性肺炎患者,无菌方法采集晨痰或下呼吸道分泌物样本接种相应培养基,感染病原菌培养鉴定按照临床微生物学检验有关规则进行操作;药敏试验采用CLSI推荐的K-B法和最新规则进行操作与评价,采用WHONET 5.5软件对数据进行统计分析。结果培养出266株病原菌,居前5位的依次为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌、鲍氏不动杆菌,分别占25.6%、16.9%、15.4%、11.7%、8.3%;主要病原菌对临床常用药物均产生了十分严重的耐药性,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别达到8.5%、13.6%;产ESBLs大肠埃希菌和肺炎克雷伯菌总检出率为43.4%;MRSA检出率为46.3%;耐药率最高的药物是磺胺甲噁唑/甲氧苄啶,均>60.0%;耐药率均>40.0%的抗菌药物有环丙沙星和庆大霉素。结论老年医院获得性肺炎病原菌的耐药现象已十分严重,医院应实施《抗菌药物临床应用管理办法》,提高医师科学合理应用抗菌药物的水平,扭转细菌耐药性快速增长的不利形势。

OBJECTIVE To investigate the distribution of pathogens causing hospital-acquired pneumonia in elderly patients and analyze the drug resistance to commonly used antibiotics so as to provide guidance for diagnosis of diseases and targeted use of antibiotics. METHODS A total of 224 patients aged more than 60 years, who were with hospital-acquired pneumonia and treated in the hospital from Jan 2010 to Dec 2012, were enrolled in the study, then the morning sputum or lower respiratory tract secretions samples were collected to inoculate On medium by the aseptic technique, the culture and identification of the pathogens were performed according to relevant regulations of clinical microbiological test, the drug susceptibility testing was conducted with the use of K-B method recommended by CLSI, the result was evaluated based on the latest regulations, and the data were statistically analyzed by using WHONET 5. 5 software. RESULTS A total of 266 strains of pathogens have been isolated, among which the Pseudomonas aeruginosa （25. 6 %）, Klebsiella pneumoniae 06. 9 %）, Staphylococcus aureus （15.4 %）, Escherichia coli （11. 7 %）, and Acinetobacter baumannii （8. 3 %） ranked the top five. The major species of pathogens have produced severe drug resistance to the commonly used antibiotics; the detection rates of imipenem-resistant P. aeruginosa and A. baumannii reached up to 8. 5 % and 13. 6 %, respectively; the total detection rate of ESBLs-producing E. coli and K. pneumoniae was 43. 4 %; the detection rate of MRSA was 46. 3 %. The drug resistance rate to sulfamethoxazole-trimethoprim was the highest （more than 60. 0 %）; the drug resistance rates to ciprofloxacin and gentamicin were more than 40. 0 %. CONCLUSION The drug resistance of the pathogens causing hospital-acquired pneumonia in the elderly patients has become very severe; it is necessary for the hospital to implement the Management of Clinical Application of Antibiotics and improve the level of scientific and reasonable use of antibiotics so as to reverse the rapid increasing tendency of bacterial resistance.