高龄呼吸道感染患者病原菌检验以及耐药性监测结果分析

Analysis of pathogenic bacteria test and drug resistance surveillance results in elderly patients with respiratory tract infections

目的分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections,and summarize the rational use of antibiotics in elderly patients with respiratory tract infections.Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test,and the test results were statistically analyzed.Results Among 701 strains of pathogenic bacteria,497 strains were Gram-negative(G-)bacteria(70.90%),136 strains were Gram-positive(G+)bacteria(19.40%)and 68 strains were fungi(9.70%).G-bacteria were mainly Klebsiellapneumoniae,Pseudomonas aeruginosa,Escherichia coli and Proteus mirabilis,accounting for 21.97%(154 strains),18.97%(133 strains),14.98%(105 strains)and 7.13%(50 strains).G+bacteria were mainly Staphylococcus aureus,accounting for 11.27%(79 strains).The top five antibiotics which G-bacteria resisted were ampicillin,piperacillin,compound sulfamethoxazole,cefazolin and ceftazidime.The resistance rates were 95.96%,85.11%,79.88%,77.06%and 52.92%,respectively.The top five antibiotics which G+bacteria resisted were penicillin,ampicillin,erythromycin,ciprofloxacin and compound sulfamethoxazole,and the drug resistance rates were 95.59%,89.71%,84.56%,80.15%and 75.00%,respectively.Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,Proteus mirabilis and Staphylococcus aureus.G-bacteria resisted ampicillin,piperacillin,compound sulfamethoxazole,cefazolin and ceftazidime the most.G+bacteria were most resistant to penicillin,ampicillin,erythromycin,ciprofloxacin and compound sulfamethoxazole,and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.