老年精神病患者呼吸道感染与牙菌斑定植菌的相关性研究

Study on relationship between respiratory tract infections in elderly patients with mental illness and dental plaque colonized bacteria

目的探讨老年精神病患者呼吸道感染与牙菌斑定植菌的相关性,分析常见牙菌斑定植菌的病原菌分布,为临床治疗提供依据。方法选取老年精神病住院患者193例,根据其口腔是否有牙菌斑定植及定植量将其分为A、B、C 3组,分别为有1种牙菌斑定植、≥2种牙菌斑定植、无牙菌斑定植,使其有可比性。结果 A、B、C组患者呼吸道感染率分别为37.50%、58.00%和13.79%,3组比较差异有统计学意义(P<0.05);A、B两组患者共检出病原菌225株,其中革兰阳性菌132株占58.67%,革兰阴性菌93株占41.33%;金黄色葡萄球菌对万古霉素、利奈唑胺及氨苄西林敏感,敏感性分别为100.00%、100.00%和98.96%,而对青霉素、红霉素敏感性较低,仅为11.46%和21.88%,大肠埃希菌和铜绿假单胞菌对亚胺培南、头孢哌酮/舒巴坦和哌拉西林/舒巴坦敏感,对氨苄西林和环丙沙星的敏感性较低。结论老年精神病患者呼吸道感染的发生与牙菌斑定植有着密切关系,定植菌越多越容易发生呼吸道感染,应加强口腔护理,减少感染发生,必要时选择敏感抗菌药物进行治疗。

OBJECTIVE To explore the relationship between the respiratory tract infections in the elderly psychiatric patients and the dental plaque colonized bacteria and investigate the distribution of common dental plaque colonized bacteria so as to provide guidance for clinical treatment .METHODS A total of 193 elderly psychiatric patients who were hospitalized were included in the study and divided into the group A ,B ,and C according to the colonization of dental plaque and colonization volume ,with the dental plaque respectively colonized with 1 species of bacterium , no less than 2 species of bacteria ,and without dental plaque colonization ,and the three groups were made compa‐rable .RESULTS The incidence of respiratory tract infections was 37 .50% in the group A ,58 .00% in the group B , 13 .79% in the group C ,and there was significant difference among the three groups （P〈0 .05） .Totally 225 strains of pathogens have been isolated from the patients of the group A and the group B ,including 132 （58 .67% ） strains of gram‐positive bacteria and 93 （41 .33% ） strains of gram‐negative bacteria .The drug susceptibility rates of the Staphylococcus aureus to vancomycin ,linezolid ,and ampicillin were 100 .00% ,100 .00% ,and 98 .96% , respectively ;the drug susceptibility rates to penicillin and erythromycin were 11 .46% and 21 .88% ,respectively . Escherichia coli and Pseudomonas aeruginosa were highly susceptible to imipenem ,cefoperazone‐sulbactam ,and piperacillin‐tazobactam ,while the drug susceptibility rates to ampicillin and ciprofloxacin were low .CONCLUSION The prevalence of the respiratory tract infections in the elderly psychiatric patients is closely related to the dental plaque colonization;the more the colonized bacteria ,the higher the risk of the respiratory tract infections is .It is necessary to strengthen the oral care to reduce the incidence of infections and choose sensitive antibiotics for treat‐ment if necessary .