社区老年患者下呼吸道感染常见病原菌及耐药性分析

Analysis of common pathogenic bacteria and drug resistance in community senile patients with lower respiratory tract infection

目的：了解近年来社区老年患者下呼吸道感染常见病原菌分布特点及耐药情况，为合理使用抗菌药物提供依据。方法：2011年6月至2014年6月3年内来院住院治疗的社区老年患者痰标本中分离的病原菌进行体外药敏试验，并进行回顾性分析。结果：分离出的临床菌株共961株，其中革兰阴性菌774株（80．6％），革兰阳性菌105株（10．9％），真菌82株（8．5％）。常见的病原菌为铜绿假单胞菌（24．9％）、肺炎克雷伯菌（22．4％）、大肠埃希菌（12．6％）、鲍曼不动杆菌（10．7％）、金黄色葡萄球菌（7．8％）。阿米卡星、加酶抑制剂的β内酰胺类、碳青霉烯类对革兰阴性敏感性较好，万古霉素、利奈唑胺、替考拉宁对革兰阳性菌有较高的敏感性，鲍曼不动杆菌的耐药率低于其他同级医院。结论：社区老年患者下呼吸道感染以革兰阴性菌为主。感染细菌耐药状况严重，应加强社区医生对细菌耐药监测工作的重视，避免单纯经验用药导致的细菌耐药性继续产生。

Objective ： To investigate the common pathogens distribution and resistance of the community gerontal patients with lower respiratory tract infection, so as to provide a basis for the guidance of rational use of antibiotics. Methods ： Test the antibiotic susceptibility of pathogens in vitro from sputum specimens of gerontal patients from June 2011 to June 2014, and the data were analyzed retrospectively.Results ： 961 strains were isolated, 774 strains of which, were Gram-negative bacteria （80.6%）, 105 strains were Gram-positive bacteria （10.9%）, 82 strains were fungi （8.5%）. The common pathogens were Pseudomonas aeruginosa （24.9%）,KlebsieUa pneumoniae （22.4%）, Escherichia col （12.6%）, acinetobacter baumanii （10.7%）, Staphylococcus aureus （7.8%）. Amikacin, β -lactamase inhibitor, carbapenem had better bactericidal effect on Gram-negative sensitivity. Vancomycin, linezolid, teicoplanin had better bactericidal on Gram-positive bacteria. The resistance rate ofacinetobacter baumanii lower than other hospital in the same scale. Conclusions ： Gram-negative bacteria was main pathogens of community gerontal patients with lower respiratory tract infection. With the high resistance rate of bacteria, we should strengthen the monitoring work of resistance antibiotics, to avoid bacteria resistance continued existence by drug experience.