高龄患者院内获得性下呼吸道感染病原学调查及耐药性分析

Investigation on Pathogens Distribution and Drug-Resistance in Old Patients With Nosocomial Lower Respiratory Tract Infection

目的 :了解高龄患者院内下呼吸道感染的病原学分布及其耐药性。方法 :分析 1997- 1999年 3年间呼吸内科病房院内下呼吸道感染的病原微生物分布情况 ,特别是高龄组病原微生物分布特点及其耐药性。结果 :(1)院内下呼吸道感染的病原微生物分布广泛 ,铜绿假单胞菌、肺炎克雷白杆菌、不动杆菌属和包括洋葱假单胞菌在内的其它假单胞菌属为优势菌 ;卡他莫拉菌感染呈增加趋势 ,高达 11.6 %。 (2 )在≥ 6 0岁病人组 ,卡他莫拉菌、大肠埃希菌、肠杆菌属细菌、铜绿假单胞菌和不动杆菌属感染发生率明显高于 <6 0岁组 ;真菌感染的发生率也显著高于 <6 0岁组。 (3)伊米配能对 4种优势细菌均有较强杀菌活性 ;头孢他啶、头孢噻肟、环丙沙星耐药率明显增加 ,其中铜绿假单胞菌和不动杆菌对头孢他啶的耐药率高达 40 % ;而头孢派酮 /舒巴坦复合制剂有较好杀菌活性 ,氨基糖苷类抗生素中的丁胺卡那霉素仍保持一定的杀菌活性 ;第一、二代头孢菌素基本耐药。结论 :在院内下呼吸道感染 (特别是高龄者 )治疗中 ,应根据病原微生物的分布特点及药物敏感性合理选择抗生素。

Objective: Our aim was to improve the management of old patients with nosocomial lower respiratory tract infection by investigating the pathogens distribution and the drug resistance. Methods: We analyzed the pathogens distribution from sputum culture from 1997 to 1999 in patients with nosocomial lower respiratory tract infections, especially those in patients older than 60 years. Results: A wide distribution of microbes existed in nosocomial pulmonary infections with a predominance of Gram negative species, including Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter, and the other pseudomonas besides Pseudomonas aeruginosa. The prevalence of Moroxiella catarralis increased to 11.6%.Incidences of infection in patients older than 60 by Moroxiella catarralis, Escherichia coli,Pseudomonas aeruginosa, Acinetobacter,and Enterobacter were significantly higher than those in patients younger than 60, as well as the fungal infection. Drug sensitivity tests against the aforementioned predominant bacteria indicated that imipenem was still active. The resistances to ceftazidime, cefotaxime, and ciprofloxacin markedly increased, with a resistance rate to ceftazidime up to 40% in Pseudomonas aeruginosa and Acinetobacter. However, sulperazone/sulbactam still had an excellent bactericidal activity , and amikacin still had bactericidal activity to some degree. The resistance to the first and second generation of cepholosporins was almost 100%. Conclusion: In patients with nosocomial pulmonary infections, especially those older than 60 years. Gram negative bacteria are the predominant pathogens which entail a potent directional antibiotics therapy based on bacteria culture results combined with the clinical settings.