42例老年人院内获得性肺炎的临床分析  

NOSOCOMIAL PNEUMONIA IN THE ELDERLY: A CLINICAL ANALYSIS

作　　者：徐轶[1] 符礼刚[1] 朱砚萍[1] 顾美娣[1] 朱惠莉[1] 

机构地区：[1]华东医院呼吸科,上海市200040

出　　处：《老年医学与保健》2005年第2期105-107,共3页Geriatrics & Health Care

摘　　要：目的初步探讨老年人院内获得性肺炎的易患因素,常见细菌及药敏,从而为更有针对性的治疗提供依据。方法回顾性总结分析我院2004年1月至6月住院的老年患者院内肺炎的发病情况、易患因素、常见致病菌和药物敏感情况。结果我院内科病房老年人院内获得性肺炎的发生率为27.5%,肺炎发生者多合并多种基础疾病,其中COPD比例最高,占71.4%,其次分别为心衰(50.0%)、糖尿病(31.1%)和脑血管疾病(35.7%)。老年人医院获得性肺炎的病原菌以革兰阴性杆菌为主,占82.8%。细菌的分离率从高到低依次为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌等。从药敏结果看,铜绿假单孢菌对多种抗生素的敏感率均较低,大肠埃希氏菌和肺炎克雷伯杆菌对除亚胺培南/西司他汀外的多种抗生素的敏感性也较低。结论老年人院内获得性肺炎的一些特点:多伴有多种基础疾病如COPD,心脑血管疾病,肾功能衰竭,恶性肿瘤;多伴有侵入性操作如胃管,导尿管,深静脉穿刺导管;引起老年人院内获得性肺炎的病原菌仍以革兰阴性杆菌为主,以铜绿假单胞菌最多。值得注意的是,多重耐药菌的比例不断增加,这与广谱抗生素的过度应用有关。Objective To explore the risk factors, common bacteria and their susceptibility of nosocomial pneumonia in elderly. Methods Retrospective survey were performed about the nosocomial pneumonia in elderly from 01/2004-06/2004. Results The incidence of nosocomial pneumonia in elderly was 27.5%, the elderly who developed nosocomial pneumonia usually had basic diseases, such as COPD (71.4%);heart failure(50.0%);diabetes mellitus(31.1%) etc. The main nosocomial pathogens were gram-negative bacilli, include Pseudomonas aeruginosa; Baumannii acinetobacter; Klebsiella pneumoniae and Escherichia coli. Pseudomonas aeruginosa had a poor sensitivity to all antibiotics; Klebsiella pneumoniae and Escherichia coli also had poor sensitivity to antibiotics except imipenem. Conclusions The elderly who developed nosocomial pneumonia usually have basic diseases, such as COPD; heart failure; diabetes mellitus ect. The main pathogens are gram-negative bacilli, especially Pseudomonas aeruginosa. Drug sensitivity test indicates that drug-resistant bacteria are increasing, this may be related to the overuse of antibiotics.

关 键 词：交叉感染 肺炎 假单胞菌 铜绿 微生物敏感性试验 

分 类 号：R563.1[医药卫生—呼吸系统]