阿尔茨海默病合并深部感染患者的病原菌分布规律及耐药性特点

Distribution patterns and drug resistance characteristics of pathogenic bacteria in inpatients with Alzheimer's disease complicated with deep infection

目的探讨阿尔茨海默病(AD)合并深部感染住院患者的病原菌分布规律及耐药性特点。方法选取AD合并深部感染患者350例为研究对象,收集患者的痰液(n=244)、尿液(n=83)、血液(n=20)及其它分泌物(n=3)标本350份分离培养得纯菌落,采用全自动微生物鉴定系统对纯菌落进行菌种鉴定;收集164例临床体征表现典型的AD合并肺部感染患者的痰标本进行分离培养得纯菌落,采用全自动微生物鉴定系统对纯菌落进行菌种鉴定,并对该164例患者的基础疾病和死亡情况进行统计;选取AD合并肺部感染排名前5的155株主要菌株进行药物敏感试验;同时收集上述菌株来源患者的肺部影像学资料。结果350份AD合并深部感染患者的标本中培养出病原菌397株,数量最多的细菌是铜绿假单胞菌(23.93%),数量最多的真菌是白念珠菌(5.04%);AD合并肺部感染的患者常常伴有多种基础疾病,伴有糖尿病的患者占比居首位(53.66%),其次是伴有高血压病的患者占比(47.56%);药敏检测结果显示,鲍曼不动杆菌对哌拉西林/他唑巴坦耐药率最高(47.36%),大肠埃希菌对环丙沙星耐药率最高(44.44%),铜绿假单胞菌对庆大霉素耐药率最高(59.25%),金黄色葡萄球菌对头孢吡肟耐药率最高(70.58%),肺炎克雷伯菌对头孢吡肟耐药率最高(38.29%);对AD合并肺部感染患者的常见影像学表现以小叶性肺炎居多,间质性肺炎及肺脓肿情况少见。结论AD合并深部感染患者的病原菌以革兰阴性菌居多,感染部位以肺部感染最高,菌株对环丙沙星、左氧氟沙星、头孢他啶、头孢吡肟及庆大霉素耐药率较高。

Objective To investigate the distribution patterns and drug resistance characteristic of pathogenic bacteria in inpatients with Alzheimer's disease(AD)complicated with deep infection.Methods A total of 350 patients with AD complicated with deep infection were selected as research subjects.A total of 350 samples were collected,including sputum(n=244),urine(n=83),blood(n=20),and other secretion(n=3)specimens from the patients to isolate and culture pure bacterial colonies.Automated microbial identification system was applied to identify bacteria species in pure colonies.Sputum samples were collected from 164 patients who had typical AD clinical signs and pulmonary infection,then isolated,cultured for obtaining pure colonies.The bacterial species in pure colonies were identified using automated microbial identification system.Statistics was performed on the underlying diseases and death status of the 164 patients.A total of 155 major strains which ranked the top 5 from the patients with AD complicated with pulmonary infections were selected for drug sensitivity testing,and their pulmonary imaging data were collected.Results A total of 397 strains of pathogenic bacteria were cultured from 350 samples of the patients with AD complicated with deep infection.The most abundant bacterium was Pseudomonas aeruginosa(23.93%),and the most abundant fungus was Candida albicans(5.04%).The patients with AD complicated by pulmonary infection often had multiple underlying diseases.Patients with diabetes accounted for the first place(53.66%),followed by the patients with hypertension(47.56%).Drug sensitivity test results showed that Acinetobacter baumannii had the highest resistance rate to piperacillin/tazobactam(47.36%),and Escherichia coli had the highest resistance rate to ciprofloxacin(44.44%).P.aeruginosa had the highest resistance rate to gentamicin(59.25%),and Staphylococcus aureus had the highest resistance rate to cephalosporin(70.58%).Klebsiella pneumoniae had the highest resistance rate to cefepime(38.29%).The common imaging manifestations of the patients with AD complicated with pulmonary infection were mainly lobular pneumonia,while interstitial pneumonia and pulmonary abscess were rare.Conclusion The majority of pathogenic bacteria in patients with AD complicated with deep infections are gram-negative bacteria,and the most common site of infection is in the lung.These strains have a high resistance rate to ciprofloxacin,levofloxacin,ceftazidime,cefepime,and gentamicin.