阿尔茨海默病患者医院感染的病原学分析及临床治疗

Etiological analysis of nosocomial infections in patients with Alzheimer's disease and clinical treatment

目的探讨阿尔茨海默病患者继发医院感染的病原学特点以及临床治疗方法,以降低阿尔茨海默病患者继发医院感染率。方法选取2011年4月-2013年5月收治阿尔茨海默病患者150例,根据临床表现对其是否发生医院感染进行初步判断,并行细菌培养及予药敏试验;采用WHONET5.4软件进行数据统计。结果 150例患者中发生医院感染21例,感染率为14.00%,其中以下呼吸道感染为主,占10.00%;132株病原菌中以革兰阴性菌为主占66.67%,其中大肠埃希菌最为常见占23.81%;革兰阳性菌占28.57%,其中以金黄色葡萄球菌占14.29%和肠球菌属占9.52%为主;真菌感染占4.76%;常见革兰阴性菌普遍对阿米卡星、亚胺培南敏感,除大肠埃希菌外均对左氧氟沙星敏感性较高,而肺炎克雷伯菌对抗菌药物普遍敏感;金黄色葡萄球菌和肠球菌属对氯霉素敏感性较高,其次是利福平,而对其他抗菌药物敏感性普遍偏低。结论阿尔茨海默病患者是发生医院感染的高危人群,应密切观察患者的临床表现,当有感染征象时早期通过细菌培养确定诊断,并及时给予经验性用药治疗,待药敏试验结果报告后,再对治疗用药进行调整。

OBJECTIVE To explore the etiological characteristics of secondary nosocomial infections in patients with Alzheimer＇s disease and put forward treatment measures so as to reduce the incidence of secondary nosocomial infections in the Alzheimer＇s disease patients.METHODS A total of 150patients with Alzheimer＇s disease who were treated in the hospital from Apr 2011to May 2013were enrolled in the study,then the preliminary observation of the incidence of nosocomial infections was performed according to the clinical manifestations,the bacterial culture and drug susceptibility testing were carried out,and the statistical analysis was performed with the use of WHONET5.4software.RESULTS Of the 150patients,the nosocomial infections occurred in 21cases with the infection rate of 14.00%,among which the patients with lower respiratory tract infections were dominant,accounting for10.00%.A total of 132strains of pathogens have been isolated;the gram-negative bacteria were the predominant pathogens,accounting for 66.67%,and Escherichia coli was the most common species,accounting for 23.81%;the gram-positive bacteria accounted for 28.57%,and Staphylococcus aureus and Enterococci were dominant,accounting for 14.29% and 9.52%,respectively;the fungi accounted for 4.76%.The common species of gramnegative bacteria were highly susceptible to amikacin and imipenem and were susceptible to levofloxacin except for E.coli,however,the Klebsiella pneumoniae was widely susceptible to the antibiotics.S.aureus and Enterococci were highly susceptible to chloramphenicol,followed by rifampicin,however,the drug susceptibility rates to other antibiotics were low.CONCLUSIONThe patients with Alzheimer＇s disease are the population at high risk of nosocomial infections.It is necessary to focus on the clinical manifestation of the patients,perform the bacterial culture in a timely manner to determine the infections,conduct the empirical medication,and adjust the drug therapy according to the result of drug susceptibility testing.