老年重症肺炎患者病原菌耐药性及死亡相关因素分析

Drug resistance of pathogens isolated from elderly patients with severe pneumonia and risk factors for death

目的分析老年重症肺炎患者临床特点、病原菌分布及耐药性特点,探讨老年重症肺炎患者死亡的危险因素。方法回顾性分析2012年9月-2013年6月医院收治的81例重症肺炎患者的临床资料,采用SPSS17.0软件进行统计分析。结果痰液标本中共分离出病原菌110株,其中革兰阴性菌83株占75.5%,革兰阳性菌14株占12.7%,真菌13株占11.8%;革兰阴性菌以铜绿假单胞菌和不动杆菌属最为常见,铜绿假单胞菌对庆大霉素、阿米卡星、亚胺培南/西司他丁敏感率分别为71.0%、80.6%、80.6%,不动杆菌属对头孢他啶及亚胺培南/西司他丁敏感率分别为53.3%、80.0%;年龄≥65岁、累计器官≥3个是老年重症肺炎患者死亡的危险因素(P<0.05)。结论对年龄>65岁并有多器官功能受损的患者应引起重视并积极综合治疗,对降低重症肺炎病死率具有重要意义。

OBJECTIVE To analyze the clinical characteristics of the elderly patients with severe pneumonia, observe the distribution and drug resistance of the pathogens, and explore the risk factors for death of the elderly patients with severe pneumonia. METHODS The clinical data of 81 patients with severe pneumonia who were treated in the hospital from Sep 2012 to Jun 2013 were retrospectively analyzed, and the statistical analysis was performed with the use of SPSS17.0 software. RESULTS A total of 110 strains of pathogens have been isolated from the sputum specimens, including 83 （75.5%） strains of gram-negative bacteria, 14 （12. 7%） strains of gram-positive bacteria, and 13 （11.8%） strains of fungi; the Pseudomonas aeruginosa and Acinetobacterbaumannii were the predominant species of gram-negative bacteria. The drug susceptibility rate of the P. aeruginosa to gentamicin was 71.0%, amikacin 80.6%, imipenem-eilastatin 80.6 % ; the drug susceptibility rate of the Acinetobacter to eeftazidime was 53.3%, imipenem-cilastatin 80.0M. The no less than 65 years of age and the number of cumulative organs no less than 3 were the risk factors for death of the elderly patients with severe pneumonia （P〈0.05）. CONCLUSION Great attention should be paid to the patients aged more than 65 years old who are complicated with multiple organ dysfunction, which has great significance in the reduction of mortality rate of the patients with severe pneumonia.