失能老人多重耐药菌感染病原菌特点及预后分析

Analysis on the characteristics and prognosis of pathogenic bacteria of multidrug-resistant bacteria infection in disabled elderly people

目的了解失能老人多重药耐药菌(MDRO)感染的病原菌分布特点及预后生存时间长短,为MDRO感染的防治提供参考。方法采用回顾性调查和前瞻性追踪相结合的方法,对2015年1月至2017年12月住院失能MDRO感染者病原菌分布及耐药性进行归纳总结,追踪患者生存时间分析其预后特点。结果174例患者所送检标本共分析出307珠MDRO,标本以痰液为主252珠占82.1%,其次为尿液占8.5%;感染部位以呼吸道感染居首占81.0%,病原菌以G-菌为主占88.92%,其次G+菌占11.08%,排在前5位的分别为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌,占比依次为34.2%、22.47%、15.32%、12.70%、10.42%;MDRO感染患者1年内死亡占94.8%,其中1月内死亡者占40.2%,1~3月者占20.1%,3~6月者占9.2%,6月至1年死亡者占25.3%,尿路MDRO感染半年以上死亡占87.5%,血培养MDRO感染1月内死亡占83.3%。结论失能老人MDRO感染部位以呼吸道为主,菌群以革兰阴性菌感染最常见,抗菌药物耐药率显著上升,病死率高,大多生存时间少于1年,血培养阳性者生存时间最短,临床应采取针对性的防治措施减少MDRO的产生。

Objective To understand the distribution characteristics and survival time of pathogenic bacteria caused by multidrug resistant bacteria(MDRO)infection in the disabled elderly,providing reference for the prevention and treatment of MDRO infection.Methods The distribution and drug resistance of pathogenic bacteria in inpatients with incapacity MDRO infection from January 2015 to December 2017 were summarized by combining retrospective investigation and prospective follow-up,and the patients′survival time was tracked to analyze their prognostic characteristics.Results A total of 307 beads of MDRO were analyzed from the samples sent by 174 patients,252 beads were mainly sputum,accounting for 82.1%,followed by urine,accounting for 8.5%.Tops the infection in respiratory tract infection(81.0%),pathogenic bacteria is given priority to with G-bacteria which accounted for 88.92%,followed by G+bacteria accounted for 11.08%,ranked in the top five were Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,E.coli,Staphylococcus aureus,The proportion was 34.2%,22.47%,15.32%and 12.70%respectively.MDRO infection patients died within 1 year(94.8%),including deaths(40.2%),1-3 month deaths accounted for 20.1%,3-6 months deaths is 9.2%,6 month-1 year deaths(25.3%),urinary tract infection of MDRO death accounted for 87.5%,more than half of the death rate from blood culture MDRO infection within 1 month was 83.3%.Conclusion The MDRO infection site in the disabled elderly is mainly respiratory tract,and the gram-negative bacteria infection is the most common bacterial flora.The antibiotic resistance rate is significantly increased,and the case fatality rate is high.The survival time of most patients is less than 1 year.