北京市某医院老年下呼吸道感染病原菌分布及耐药性分析

Analysis on the Distribution and Drug Resistance of the Pathogenic Bacteria Causing Lower Respiratory Tract Infection in Senile Patients in a Hospital in Beijing

目的分析老年下呼吸道感染患者病原菌的分布及耐药性,为临床防治提供依据。方法回顾性分析2012年2月—2013年11月在北京市隆福医院呼吸科住院的老年下呼吸道感染438例痰标本培养分离的病原菌种类及其药物敏感试验结果。结果 438例标本中共检出病原菌392株,其中革兰阴性菌226株(57.7%),以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌为主;革兰阳性菌125株(31.9%),以金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌为主;真菌41株(10.5%),以白假丝酵母菌为主。药物敏感试验结果显示:肺炎克雷伯菌和大肠埃希菌对亚胺培南的耐药率最低,鲍曼不动杆菌对头孢哌酮钠-舒巴坦钠及亚胺培南耐药率较低,铜绿假单胞菌对阿米卡星耐药率最低。金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌对万古霉素、替考拉宁全部敏感。结论老年下呼吸道感染病原菌以革兰阴性菌为主,细菌耐药性严重,应根据药物敏感试验结果选用合适的抗菌药物。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in senile patients with lower respiratory tract infection, and provide a reasonable basis of prevention and treatment for the clinic. Methods The culture and drug sensitive test results of pathogenic bacteria separated from 438 sputum samples from senile patients with lower respiratory tract infection in Department of Respiratory Medicine from February 2012 to November 2013 were retrospectively analyzed. Results There were 392 strains separated from 438 samples. Among the 392 strains, 226 strains （57. 7%） were gram-negative, mainly including klebsiella pneumoniae, escherichia coli, pseudomonas aeruginosa and Bauman acinetobacter. While 125 strains （31. 9%） were gram-positive, which mainly contained staphylococcus aureus, staphylococcus haemolyticus and staphylococcus epidermidis. Forty-one strains （10. 5%） were fungi, and candida albicans was the most. Drug sensitive test results showed that klebsiella pneumoniae and escherichia coli had lowest resistance to imipenem, Bauman acinetobacter had lower resistance rates to sulbactam and cefoperazone and imipenem, and pseudomonas had the lowest resistance rate to amikacin. Staphylococcus aureus, staphylococcus haemolyticus and staphylococcus epidermidis were all sensitive to vancomycin and teicoplanin. Conclusion Gram-negative bacterium is the major pathogenic bacteria in geriatric patients with lower respiratory tract infection. The situation of bacterial drug resistance is serious, and we should choose rational antibacterials according to drug sensitive test.