老年医院获得性肺炎病原学及药物敏感性分析

Pathogens and drug-susceptibility of hospital acquired pneumonia in elderly patients

目的调查老年住院患者医院获得性肺炎（HAP）的病原学分布及药物敏感性,为临床治疗提供参考。方法回顾性分析2010年1月至2015年12月在首都医科大学附属北京友谊医院老年内科住院并诊断为HAP的老年患者的病原学及药物敏感性资料。结果共纳入600例老年HAP患者,占同期老年内科住院患者医院获得性感染的59.9%（600/1 001）。2010年至2015年老年HAP发生例数分别为60例、89例、75例、67例、155例和154例,晚发HAP占87.5%（525/600）。600例老年HAP患者中81.3%（488/600）病原学检查阳性,最常见的病原菌依次为铜绿假单胞菌（21.5%,105/488）、鲍曼不动杆菌（21.3%,104/488）、金黄色葡萄球菌（17.2%,84/488）、白色念珠菌（10.5%,51/488）和肺炎克雷伯杆菌（5.1%,25/488）。铜绿假单胞菌对氨基糖甙类抗生素的敏感率最高（83.2%~95.5%）,哌拉西林/他唑巴坦次之（79.3%）,对美罗培南和亚胺培南的敏感率仅为54.5%和52.6%。鲍曼不动杆菌几乎对所有常用抗菌药物的敏感率均低于50%,对亚胺培南耐药率高达84.3%。肺炎克雷伯菌对亚胺培南、阿米卡星和头孢替坦敏感率高于80%,对其他抗菌药物敏感率均低于80%。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的85.7%（72/84）,对万古霉素、利奈唑胺、奎奴普丁/达福普汀和替加环素100%敏感。结论 HAP是老年住院患者最常见的医院获得性感染。老年HAP患者最常见的分离菌是铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、白色念珠菌和肺炎克雷伯菌。老年HA P常见致病菌多重耐药情况严重,需引起关注。

Objective To investigate the pathogens and drug - susceptibility of hospital acquired pneumonia （HAP） in elderly inpatients so as to provide reference for clinical management. Methods Pathogens and drug - susceptibility of hospital acquired pneumonia in elderly patients hospitalized in the department of geriatric medicine, Beijing Friendship Hospital from January 2010 to December 2015 were investigated retrospectively. Results Six hundred elderly cases with HAP were enrolled in this study, with a ratio of 59.9% of all hospital acquired infections in the department of geriatric medicine during the period of 2010 to 2015. The nulnbers of elderly HAP cases were 60,89,75,67, 155 and 154 case from 2010 to 2015 respectively. Late - onset HAP was in the majority of the overall cases（87.5% , 525/600）. Pathogens were identified in 488 cases （ 81.3 % ） , including pseudomonas aeruginosa （21.5 % , 105/488 ） , Acinetobacter baumannii （21.3 % , 104/488 ） , Staphylococcus aureus （ 17.2% , 84/488） , Candida albicans （ 10.5% , 51/488 ） and Klebsiella pneumonia （5.1% , 25/488 ） , which were the most common pathogens. The susceptibility of P. aeruginosa to aminoglycoside antibiotics were the highest （ 83.2% - 95.5 % ）, then was piperacillin/tazobactam （79.3%）. The susceptibility of P. aeruginosa to meropenem and imipenem were 54.5% and 52.6% respectively. A. baumannii showed low susceptibility of less than 50% to almost all kinds of antibiotics, with a high resistance rate of 84.3% to imipenem. K. pneumonia showed a high susceptibility of more than 80% to imipenem, amikacin and cefotetan, and low susceptibility of less than 80% to all the other antibiotics. Methicillin - resistant Staphylococcus aureus （MRSA） accounted for 85.7% （ 72/84 ） in all isolated strains of S. aureus. The susceptibility of MRSA to vancomycin, linezolid, quinupristin/dalfopristin and tigecycline were all 100%. Conclusion HAP is the most common hospital acquired infection in elderly inpatients. The most frequently identified pathogens of elderly HAP are p. aeruginosa, A. baumannii, S. aureus, C. albicans and K. pneumonia. The frequent pathogens of elderly HAP show high resistance rates to antibiotics and should be payed more attention.