虎门地区老年人肺部感染病原菌的分布及耐药性

Pathogenic bacterial distribution and drug resistance in elderly patients with pulmonary infection in Humen region

目的了解广东省东莞市虎门老年人肺部感染病原菌的临床分布和耐药状况,为改善老年人生存质量及合理抗感染提供用药依据。方法收集东莞市第五人民医院2016年2月至2019年2月住院部各科室老年患者送检的痰标本中分离的病原菌及药敏数据进行回顾性分析。结果从老年感染患者送检的痰标本中分离到的病原菌共936株(除去重复菌株),以革兰阴性杆菌为主(85.90%),其次是革兰阳性球菌(8.01%)、真菌(4.59%)和其他细菌(1.50%)。分离率排名前5位的菌株依次是铜绿假单胞菌(32.91%)、鲍曼不动杆菌(28.10%)、肺炎克雷伯菌(10.90%)、大肠埃希菌(5.02%)及金黄色葡萄球菌(4.60%)。碳青霉烯类抗菌药物依然对铜绿假单胞菌及肠杆菌科细菌保持良好的抗菌活性,但对鲍曼不动杆菌敏感性差。鲍曼不动杆菌对米诺环素及头孢哌酮/舒巴坦较为敏感。革兰阳性球菌对四环素类抗菌药物及氨苄西林耐药率较高,分离的革兰阳性球菌中尚未发现耐万古霉素、奎奴普丁/达福普汀或利奈唑胺的菌株。同时,肺部感染的老年患者中具有一定比例的患者有肺外合并症,并且其他感染相关指标也出现异常。结论革兰阴性杆菌是引起老年患者肺部感染的主要病原菌,同时真菌感染也不容忽视,患者临床症状迁延。老年患者身体基础状态欠佳,常有抗菌药物使用暴露史,分离菌耐药率具有一定的人群特征性。针对老年患者抗肺部感染的同时,防治其他合并症也相当重要。定期监测病原菌的分布和耐药性变化,对老年患者肺部感染的防治及合理用药有重要的意义,对防止多重耐药菌产生、提高治愈率有积极作用。

Objective To understand the clinical distribution and drug resistance situation of pathogenic bacteria among elderly patients with pulmonary infection in Humen area of Dongguan City of Guangdong Province in order to provide the medication evidence for improving the living quality and rational anti-infection in elderly people.Methods The data of pathogenic bacteria isolated from the clinically submitted sputum samples among the elderly inpatients in various departments of the inpatients department and drug susceptibility test in the Dongguan Municipal Fifth People′s Hospital from February 2016 to February 2019 were collected for conducting the retrospective analysis.Results A total of 936 strains of pathogenic bacteria were isolated from the sputum samples submitted by elderly infected patients(excluding repeat strains).Among them,Gram-negative bacilli were predominant(85.90%),followed by Gram-positive cocci(8.01%),fungi(4.59%)and other bacteria(1.50%).The top five of isolation rates were in turn Pseudomonas aeruginosa(32.91%),Acinetobacter baumannii(28.10%),Klebsiella pneumoniae(10.90%),Escherichia coli(5.02%)and Staphylococcus aureus(4.60%).Carbapenems still maintained good antibacterial activity against pseudomonas aeruginosa and enterobacteriaceae,but had poor sensitivity to Acinetobacter baumannii.Acinetobacter baumannii was more sensitive to minocycline and cefoperazone/sulbactam.The drug resistance rate of positive cocci to tetracycline and ampicillin was higher,and no strains resistant to vancomycin,quinupristin/dalfopristin or linezolid were found in the isolated gram-positive cocci.A certain proportion of elderly patients with pulmonary infection had extrapulmonary complications,moreover the other infection-related indicators also showed abnormalities.Conclusion Gram-negative bacilli are the main pathogenic bacteria causing pulmonary infection in elderly patients.Meanwhile the fungal infection also cannot be ignored,and the clinical symptoms persist.The body basic status in elderly patients is not good enough,they usually have the antibacterial drug exposure history,so the drug resistance rates of isolated bacteria have certain population characteristics.In other words,it is important to prevent and treat other complicating diseases while aiming at anti-lung infection in elderly patients.Regular monitoring of the distribution of pathogenic bacteria and changes in drug resistance is of great significance for the prevention and treatment of pulmonary infection and rational medication in elderly patients,which also plays a positive role in preventing the emergence of multi-drug-resistant bacteria and improving the cure rate.