痰液标本细菌培养及药敏试验对下呼吸道感染用药的指导作用

The influence of bacterial culture and susceptibility test results of sputum specimens on the rational use of antibiotics in elderly patients with lower respiratory tract infection

目的分析痰液标本细菌培养及药敏试验结果分析对下呼吸道感染老年患者抗菌药物合理使用的影响。方法选取我院2018年10月至2020年4月下呼吸道感染老年患者372例,均行痰液标本细菌培养及药敏试验,统计痰液标本细菌培养结果,分析主要病原菌构成,分析药敏试验结果,统计主要革兰阴性菌及主要革兰阳性菌耐药性。结果372例患者共分离致病菌435株,其中革兰阴性菌256株,占比为58.85%,以肺炎克雷伯菌(24.14%)、大肠埃希菌(15.86%)、铜绿假单胞菌(11.72%)为主;革兰阳性菌109株,占比25.06%,以金黄色葡萄球菌(13.10%)、凝固酶阴性葡萄球菌(8.05%)为主;真菌70株,占比16.09%。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌等主要革兰阴性菌对亚胺培南耐药性较低,金黄色葡萄球菌、凝固酶阴性葡萄球菌等主要革兰阳性菌对万古霉素耐药性较低。结论下呼吸道感染患者主要致病菌构成为以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌等为主的革兰阴性菌及以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主的革兰阳性菌。通过药敏试验可分析主要病原菌耐药性,对革兰阴性菌感染患者可选择亚胺培南,对革兰阳性菌感染患者可在考虑用药安全性的基础上选择万古霉素,对临床合理用药有指导作用。

Objective To analyze the influence of bacterial culture of sputum specimens and analysis of drug sensitivity test results on the rational use of antibiotics in elderly patients with lower respiratory tract infection.Methods A total of 372 elderly patients with lower respiratory tract infections in our hospital from October 2018 to April 2020 were selected for bacterial culture and drug sensitivity test of sputum samples.The results of bacterial culture of sputum specimens were counted,the composition of main pathogenic bacteria was analyzed,the results of drug sensitivity test were analyzed,and the drug resistance of main gram-negative bacteria and main gram-positive bacteria was counted.Results A total of 435 pathogenic bacteria were isolated from 372 patients,of which 256 were gram-negative bacteria,accounting for 58.85%.Klebsiella pneumoniae(24.14%),Escherichia coli(15.86%),and Pseudomonas aeruginosa(11.72%)were the main ones;there were 109 gram-positive bacteria,accounting for 25.06%,mainly Staphylococcus aureus(13.10%)and coagulase-negative Staphylococcus(8.05%);there were 70 fungi,accounting for 16.09%.Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and other major gram-negative bacteria had low resistance to imipenem.Major gram-positive bacteria such as Staphylococcus aureus and coagulase-negative staphylococcus had low resistance to vancomycin.Conclusion The main pathogenic bacteria in patients with lower respiratory tract infection are gram-negative bacteria mainly composed of Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and gram-positive bacteria mainly composed of Staphylococcus aureus and coagulase-negative staphylococcus.The drug susceptibility test can be used to analyze the drug resistance of the main pathogens.Patients with gram-negative bacteria infection can choose imipenem for empirical medication,and patients with gram-positive bacteria infection can choose vancomycin based on the safety of medication,which has a guiding role in clinical rational use of drugs.