耳鼻咽喉科老年患者多重耐药菌感染的临床特征和耐药性分析

Analysis of Antimicrobial Agents Resistance and Clinical Characteristic of Multidrug-Resistant Bacterial Infections in Elderly Patients in the Department of Otolaryngology

目的了解耳鼻咽喉科老年患者感染多重耐药菌的特点,为指导临床合理使用抗生素、有效预防和控制该类感染提供依据。方法回顾性分析472例耳鼻咽喉科老年患者感染多重耐药细菌的临床资料,并按社区感染及医院感染分别研究其感染特征及病原菌分布,且对最常见的社区感染和医院感染多重耐药菌进行耐药率的统计分析。结果耳鼻咽喉科老年患者多重耐药的革兰阳性菌和革兰阴性菌在社区感染率及医院感染率方面,差别有统计学意义(P<0.05)。社区感染以革兰阳性菌为主(62.9%),致病多重耐药革兰阳性菌以金黄色葡萄球菌为主(37.8%),且主要分布在耳鼻咽喉的慢性炎症疾病;医院多重耐药菌感染以革兰阴性菌为主,又以多重耐药的肺炎克雷伯菌感染为主(32.7%),主要分布在耳鼻咽喉头颈部恶性肿瘤等大型手术的围手术期;社区及医院感染多重耐药的金黄色葡萄球菌对常见抗生素的耐药率比较,差别无统计学意义(P>0.05)。除了对头孢呋辛及左氧氟沙星的耐药率差别有统计学意义外(P<0.05),社区及医院感染多重耐药的肺炎克雷伯菌对其余多种常见抗生素的耐药率差别均无明显统计学意义(P>0.05)。结论耳鼻咽喉多重耐药细菌感染多发生于老年患者,合理使用抗生素,提高老年患者耳鼻咽喉疾病的诊断,加强住院管理,提高标本送检率,可减少耳鼻喉科老年患者多重耐药菌感染的发生。

Objective To guide the reasonable antibiotic clinical use and provide a reference for effective prevention and control to this type of infection by understanding the clinical features of multi-drug resistant(MDR)bacterial infection of elderly patients in the department of otolaryngology.Methods We retrospectively analyzed data on clinical specimens of472cases of elderly patients in the recent7years.The clinical data were used to analyze multi-drug resistant bacterial infections characteristics and pathogen distribution.A statistical analysis was made on the most common community infection and nosocomial infection of multidrug-resistant bacteria.Results There was a significant difference in the rates of multidrug-resistant gram-positive and gram-negative bacteria between community and nosocomial infection of elderly patients in the department of otolaryngology(P<0.05).Gram-positive bacteria are dominant in community infection in elderly patients with otolaryngology disease.The multiple drug-resistant bacteria pathogenic were mainly on gram-positive Staphylococcus aureus'which accounted for37.8%.Community acquired infections were mainly composed by otolaryngology chronic inflammation diseases of elderly patients.Gram-negative bacteria were dominant in nosocomial infection of elderly patients in the department of otolaryngology.The multiple drug-resistant bacteria pathogenic were mainly on gram-negative Klebsiella pneumoniae,which accounted for32.7%.However,the nosocomial infections mainly occurred in perioperative period of otolaryngology head and neck malignant tumor of elderly patients.There were no significant differences in the rates of multi-drug resistant to Staphylococcus aureus between community and nosocomial infection in otolaryngology elderly patients(P>0.05).Other than cefuroxime and levofloxacin(P<0.05),there was also no significant difference in the rates of multi-drug resistant to most antibiotics between community and nosocomial infection in otolaryngology elderly patients(P>0.05).Conclusions The elderly patients are more susceptible to multi-drug resistant bacterial infections in the department of otolaryngology.To reduce the occurrence of multiple drug-resistant infections,we should make the use of antibiotics reasonable,improve the diagnosis of otorhinolaryngologic diseases in elderly patients,strengthen the management of hospitalization and increase the examination rates of specimens of the elderly patients in the department of otolaryngology.