重症感染老年患者治疗前后痰培养结果的临床研究

Clinical study of results of sputum culture for elderly patients with severe infections before and after treatment

目的探讨内分泌科重症感染老年患者抗感染治疗前后痰培养结果的改变以及影响患者预后的因素,以降低感染率。方法选取内分泌科收治的重症感染老年患者87例,于治疗前以及治疗后每周进行1次痰培养,记录培养结果;在患者治疗4周后,根据治疗效果将其分为有效组58例和无效组29例,对两组患者的临床资料进行统计,分析影响治疗效果的因素。结果经治疗,继续接受治疗患者逐渐减少,但痰培养细菌阳性率逐渐升高,在第4周,仍然有36例患者接受治疗,这些患者痰培养全部为阳性;治疗前共检出病原菌66株,其中革兰阴性菌51株占77.27%,革兰阳性菌10株占15.15%,真菌4株占6.06%;随着治疗时间的推移,接受治疗患者的病原菌谱无显著性变化;随着治疗的进行,菌株清除率逐渐升高,但是也不断的有新菌株定植;无效或死亡患者中肾功能不全者明显多于显效有效患者,两组比较差异有统计学意义(P<0.05)。结论铜绿假单胞菌是内分泌科重症感染老年患者常见病原菌,且随着治疗患者的细菌菌谱也随之变化,在临床治疗过程中应根据药敏试验选择敏感抗菌药物的同时适当应用广谱抗菌药物,同时主要保护患者的肾功能。

OBJECTIVE To explore the change of results of sputum culture for the elderly patients with severe infections in endocrinology department before and after the anti-infection therapy and observe the influencing factors for clinical outcomes so as to reduce the infection rate.METHODS A total of 87 elderly patients with severe infections who were treated in the endocrinology department were enrolled in the study,then the sputum culture was performed before the treatment and once per week after the treatment,and the culture results were recorded;at week 4of treatment,the patients were divided into the effective group with 58 cases and the ineffective group with29 cases according to the curative effect;the clinical data of the two groups of patients were statistically analyzed,and the influencing factors for the curative effect were observed.RESULTS Through the treatment,the number of the patients who received continuous treatment was decreased,but the positive rate of sputum culture was gradually increased;on week 4,there were still 36 patients who received the treatment,and the sputum culture was negative for all the patients.Totally 66 strains of pathogens have been isolated before the treatment,including 51（77.27%）strains of gram-negative bacteria,10（15.15%）strains of gram-positive bacteria,and 4（6.06%）strains of fungi.Along with the treatment time,the spectrum of the pathogens isolated from the patients receiving the treatment did not change significantly;the clearance rate of the strains was increased with the treatment,but newly colonized strains continuously emerged;the proportion of the patients with renal dysfunction was significantly greater among the patients who were ineffective for the treatment or died than among the patients who were effective for the treatment,there was significant difference（P〈0.05）.CONCLUSION The Pseudomonas aeruginosais a common species of pathogen causing severe infection in the elderly patients of endocrinology department,and the bacterial spectrum changes along with the treatment.It is necessary to reasonably use broad spectrum antibiotics during the clinical treatment on the basis of the drug susceptibility testing and at the same time to protect the renal function.