肺炎链球菌致老年患者社区获得性肺炎的危险因素与临床耐药性

The risk factors and clinical drug resistance of Streptococcus pneumoniae-associated community-acquired pneumonia in elderly patients

目的了解肺炎链球菌致老年患者社区获得性肺炎的危险因素与耐药特征,为临床合理使用抗菌药物,有效预防和控制感染提供依据。方法收集2011年1月至2014年12月金华市第二医院老年科住院患者下呼吸道标本中分离的肺炎链球菌253株,均经全自动微生物鉴定仪鉴定,药敏试验采用纸片扩散法(K-B),结果按美国临床和实验室标准协会(CLSI)标准判读,采用WHONET 5.6软件进行耐药性分析。结果调查显示感染的最危险因素是患者年龄≥60岁,主要标本来源于痰液(75.5%);药敏试验表明肺炎链球菌对克林霉素、红霉素、四环素和复方新诺明的耐药率最高,分别为90.1%、86.2%、81.4%和76.7%,而对阿莫西林、万古霉素、莫西沙星、替考拉宁和利奈唑胺的耐药率<2.0%。结论肺炎链球菌是引发本院老年患者社区获得性肺炎的主要致病菌,主要检出于痰标本,其耐药情况较为严重,表现出多药耐药,临床必须加强对肺炎链球菌的耐药性监测,阿莫西林、万古霉素、莫西沙星、替考拉宁和利奈唑胺可作为治疗该菌感染的首选药物。

Objective To understand the risk factors and resistance characteristics of Streptococcus pneumoniae in elderly patients with community-acquired pneumonia so as to provide the basis for rational use of antimicrobial drugs,and prevention and control of the infection.Methods 253 strains of Streptococcus pneumoniaisolated from the lower respiratory tract of elderly inpatients in the Second Hospital of Jinhua from Jan2011 to Dec 2014 were collected and identified with full-automated microbacterial identification system;the drug resistance was determined with K-B susceptibility test.The results were interpreted based on the American Clinical Laboratory Standards Institute（CLSI）standard.WHONET 5.6software was used to analyze the drug resistance.Results The highest risk factor was the age ≥60years.Most of the pathogen came from sputum specimens（75.5%）.The highest resistance rates of Streptococcus pneumoniae were to Clindamycin（90.1%）,Erythromycin（86.2%）,Tetracycline（81.4%）and Sulfamethoxazole（76.7%）,while those to Amoxicillin, Vancomycin, Moxifloxacin,Teicoplanin and Linezolid were 2.0%.Conclusion Streptococcus pneumoniae is the main pathogenic bacteria in our hospital in elderly patients with community-acquired pneumonia,mainly detected from sputum specimens,which is highly resistant and even multi-resistant.The clinical monitoring of drug resistance must be strengthened.Amoxicillin,Vancomycin,Moxifloxacin,Teicoplanin and Linezolid can be used as the options of treatment.