老年患者下呼吸道医院感染病原菌分类与耐药性分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in elderly patients

目的了解老年患者下呼吸道医院感染的病原菌种类与耐药性,为临床医师预防感染及选择药物治疗提供可靠的参考依据。方法对2010年1月-2012年12月下呼吸道感染患者标本采集、病原菌培养、菌种鉴定按照卫生部编印的《全国临床检验操作规程》中的临床微生物学检验进行;药敏监测试验的操作采用CLSI推荐的K-B法,敏感、中介、耐药的界定依据CLSI最新折点评价;试验全过程实施分析前、分析中、分析后质量控制;数据处理采用WHONET5.5软件分析。结果老年肺炎患者痰液培养出的302株病原菌,革兰阴性杆菌199株占65.9%、革兰阳性球菌75株占24.8%、真菌28株占9.3%;分离前5位的病原菌为铜绿假单胞菌占24.2%、肺炎克雷伯菌占19.2%、金黄色葡萄球菌占18.9%、大肠埃希菌占8.9%、鲍氏不动杆菌占8.3%;5种病原菌对临床抗菌药物均表现较为严重的耐药性,革兰阴性菌对阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率≤20.0%;革兰阳性菌对万古霉素、替考拉宁100.0%敏感;产超广谱β-内酰胺酶(ESBLs)细菌检出率为41.2%,耐甲氧西林金黄色葡萄球菌检出率达38.6%。结论老年患者下呼吸道医院感染病原菌的抗药性逐年加重,医院应强化执行《抗菌药物临床应用管理办法》,采取强制性管理,综合性治理,以扭转目前医院流行细菌的抗药性快速增长的不良倾向。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing lower respiratory tract infections in the elderly patients so as to provide reliable bases for prevention of infections and use of antibiotics.METHODS From Jan 2010to Dec 2012,the collection of lower respiratory tract specimens,culture of pathogens,and identification of pathogens were performed according to the clinical microbiological examination of National Guide to Clinical Laboratory Procedures specified by the Ministry of Health,the drug susceptibility testing was performed with the use of K-B method recommended by CLSI,the drug susceptibility,resistance or intermediate was defined according to the latest break points of CLSI,the quality control was followed before,during and after the analysis,and the statistical analysis was performed by using WHONET5.5software.RESULTS Total of302strains of pathogens have been isolated from the sputum specimens obtained from the elderly patients with pneumonia,consisting of 199（65.9%）strains of gram-negative bacilli,75（24.8%）strains of gram-positive cocci,and 28（9.3%）strains of fungi;the Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus,Escherichia coli,and Acinetobacter baumannii ranked the top five species of pathogens,accounting for24.2%,19.2%,18.9%,8.9%,and 8.3%,respectively.The five species of pathogens were highly resistant to the clinical antibiotics;the drug resistance rates of the gram-negative bacteria to amikacin,imipenem,meropenem,cefoperazone-sulbactam,and piperacillin-tazobactam were no more than 20.00%;the drug susceptibility rates of the gram-positive bacteria to vancomycin and teicoplanin were 100.0%.The isolation rate of the extended-spectrum-lactamases（ESBLs）-producing bacteria was 41.2%,and the isolation rate of the methicillin-resistant Staphylococcus was 38.6%.CONCLUSION The drug resistance of the pathogens causing lower respiratory tract infections in the elderly patients is increased year by year.It is necessary for the hospital to intensify the implementation of Management of Clinical Application of Antibiotics and take mandatory management and comprehensive treatment measures so as to reverse the rapid growth of drug resistance of the pathogens that are prevalent in the hospital.