肾内科老年患者肺部感染的病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in elderly patients hospitalized in department of nephrology

目的分析肾内科老年肺部感染患者的病原菌分布及耐药性,以降低感染率。方法对2008年9月-2013年6月收治的肾内科46例老年肺部感染住院患者临床资料进行回顾性分析,对患者感染的病原菌分布及其耐药性进行统计,探讨相应的干预对策。结果 46例肾内科老年肺部感染患者共分离出病原菌62株,其中革兰阴性菌38株占61.3%,以大肠埃希菌与铜绿假单胞菌为主,革兰阳性菌24株占38.7%,以金黄色葡萄球菌与粪肠肠球为主;大肠埃希菌对头孢他啶、氨曲南、庆大霉素及头孢吡肟的耐药率较高均>80.0%,铜绿假单胞菌对头孢他啶、氨曲南、哌拉西林/他唑巴坦的耐药率较高均>77.0%,金黄色葡萄球菌对阿奇霉素、红霉素、克林霉素、苯唑西林、青霉素的耐药率较高>66.0%,粪肠球菌对克林霉素、阿奇霉素、红霉素、磺胺甲噁唑/甲氧苄啶的耐药率较高>77.0%。结论肾内科老年住院患者感染的病原菌分布相对集中,与医院环境、病房环境等关系密切,应加强病房环境中主要致病菌的清洁消毒工作,降低医院感染的发生率。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing pulmonary infec-tions in elderly patients hospitalized in the department of nephrology so as to reduce the infection rate.METHODS The clinical data of 46 elderly patients with pulmonary infections who were hospitalized from Sep 2008 to Jun 2013 were retrospectively analyzed,the distribution and drug resistance of the pathogens causing infections were statis-tically analyzed,and the corresponding intervention countermeasures were put forward.RESULTS A total of 62 strains of pathogens have been isolated from the 46 elderly patients who were hospitalized in the department of nephrology,including 38 （61.3%）strains of gram-negative bacteria and 24 （38.7%）strains of gram-positive bac-teria;the Escherichia coli and Pseudomonas aeruginosa were the predominant species of gram-negative bacteria;the Staphylococcus aureus and Enterococcus faecalis were dominant among the gram-positive bacteria.The drug resistance rates of the E.coli to ceftazidime,aztreonam,gentamicin,and cefepime were more than 80.0%;the drug resistance rates of the P.aeruginosa to ceftazidime,aztreonam,and piperacillin-tazobactam were more than 77.0%;the drug resistance rates of the S.aureus to azithromycin,erythromycin,clindamycin,oxacillin,and pen-icillin were more than 6 6 .0%;the drug resistance rates of the E.faecalis to clindamycin,azithromycin,erythro-mycin,and sulfamethoxazole-trimethoprim were more than 77.0%.CONCLUSION The pathogens causing infec-tions in the elderly patients hospitalized in the department of nephrology show relatively concentrated distribution, which is closely related to the hospital environment and ward environment.It is necessary to strengthen the clean-ing and disinfection of the major pathogens in the ward environment so as to reduce the incidence of nosocomial in-fections.