高龄患者血液感染常见革兰阴性杆菌及其耐药性分析

Distribution and drug resistance of Gram-negative bacteria from blood samples of elderly patients

目的分析本院80~100岁高龄患者血液感染常见革兰阴性杆菌的种类及其耐药状况,为本院合理使用抗生素提供依据。方法采用BacT/Alert 3D血培养仪对血液标本进行阳性鉴定;VITEK-2Compact全自动微生物鉴定仪进行鉴定;K-B纸片扩散法对抗菌药物进行敏感性测定;使用WHONET 5.4分析软件分析数据。结果本院高龄患者血液培养阳性标本中共分离出革兰阴性杆菌108株,以肠杆菌科细菌为主,其次为非发酵菌,前者主要为大肠埃希菌52株（48.15%）和肺炎克雷伯菌37株（34.26%）,后者主要包括铜绿假单胞菌10株（9.26%）和鲍曼不动杆菌8株（7.41%）。其中大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为1.92%和13.51%,两者对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛的耐药率均高于50.00%;铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为20.00%和25.00%,后者对其他抗菌药物的耐药率均高于前者。结论碳青酶烯类抗生素可作为本院高龄患者常见革兰阴性杆菌所致血液感染的首选药物;但在治疗中应考虑细菌的耐药特点及患者的代谢特点合理选择抗生素。

Objective To analyze the distribution and drug resistance of Gram-negative bacteria from blood cultures of elderly patients（80-100 years old）in Shaoxing municipal hospital,and provide scientific evidence for clinically reasonable use of antibiotics.Methods Blood cultures were detected by using BacT/Alert 3D automated blood culture system;bacteria were identified by using VITEK-2Compact identification system;susceptibility to antimicrobial agents was determined by using standard disk diffusion method.WHONET5.4software was used to analyze the data.Results A total of 108 strains of Gram-negative bacteria were isolated,the majority of which was Enterobacteriaceae,followed by non-fermenting bacteria.The former was composed of Escherichia coli（52strains,48.15%）and Klebsiella pneumoniae（37strains,34.26%）,while the latter included Pseudomonas aeruginosa（10strains,8.33%）and Acinetobacter baumannii（8strains,7.41%）.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem were 1.92%and 13.51%respectively,and were over 50.00%to ampicillin,ampicillin/sulbactam,cefazolin and cefuroxime.The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 20.00%and 25.00%respectively;the drug resistance rates of Acinetobacter baumannii to other antimicrobial agents were higher than those of Pseudomonas aeruginosa.Conclusion Carbapenem antibiotics can be used as the first choice to Gram-negative bacteria isolated from the blood of elderly patients.Rational use of antibiotics based on the results of drug susceptibility and metabolic characteristics of elderly patients is strongly recommended.