老年人下呼吸道感染革兰阴性杆菌的分布及药敏分析  

Gram-negative bacilli distribution and drug resistance analysis in lower respiratory tract of elderly patients

作　　者：王潭枫[1] 席云[1] 

机构地区：[1]中山大学附属第三医院检验科,510630

出　　处：《中国临床实用医学》2009年第11期63-64,共2页China Clinical Practical Medicine

基　　金：广州市科技计划项目（项目编号：2006Z1-E0141）

摘　　要：目的 了解老年人下呼吸道感染革兰阴性（G^-）杆菌的分布及药敏情况，为临床用药提供依据。方法对2006年3月至2008年6月期间在住院的老年人下呼吸道感染患者痰液标本中分离到937株G^-杆菌，采用Microscan Walk Away仪进行鉴定和药敏试验，所得结果进行统计分析。结果G^-杆菌中分离率最高的前三种是大肠埃希氏菌（36．6％）、肺炎克雷氏菌（19．7％）和铜绿假单胞菌（17．0％），它们产ESBLS分离率分别是48．4％、61．2％和32．1％。大肠埃希氏菌和肺炎克雷伯菌对亚胺培南和丁胺卡那敏感率最高，分别是100％和88．4％～91．3％，对头孢类、磺胺类和青霉类抗生素均有不同程度的下降。铜绿假单胞菌对各种抗生素敏感率低，哌拉西林／他巴唑坦也仅在76．8％，对阿莫西林／克拉维酸与头孢噻肟的敏感率最低，均仅3．2％，其次是头孢曲松，为12．3％。结论老年人下呼吸道感染革兰氏性杆菌ESBLS检出率高，对各种抗生素敏感率低，且呈多重性耐药性，应引起临床关注。Objective To study drug resistance and distribution of infectious gram-negative bacillus in lower respiratory tract of elderly patients to use the experience for reference of clinical application. Methods 937 strains of gram-negative bacillus isolated from the qualified sputum sample of elderly patients who were admitted from March 2006 to June 2008 were done. The drug sensitivity tests were done for the positive bacterium by the GNS-NT cards of bacterium inspection and the drug resistance was measured with Microscan Walk Away. All data was analyzed at last. Results The 3 most common isolated gram-negative bacillus were Bacillus coli （36. 6% ） ,Klebsiella pneumoniae（ 19.7% ） ,and Bacillus pyocyaneus（ 17.0% ） ,the detection rates of the producing ESBLs were 48.4% , 61.2%, 32. 1% respectively. The drug resistances of Bacillus coli and Klebsiella pneumoniae for cephalosporins, sulfonamides, and penicillins antibiotics were all elevated, except that for Imipenem, and Amikacin. The drug-sensitivity rates were 100%, 88.4% -91.3% respectively. Bacillus pyocyaneus had the higher drug-sensitivity rates of 76. 8% for Pip/Tazo, drug-sensitivity rate of Bacillus pyocyaneus to Amox/K Clav（ 3.2% ） and Ceftriaxone（ 12. 3% ） was significantly lower than another antibiotics. Conclusion Gram-negative bacilli have become the major pathogens in lower respiratory tract infections had the higher ratio of producing ESBLs and lower drug-sensitivity with high multidrug resistance. We should select the antibiotic according to the results of drug sensitivity test.

关 键 词：下呼吸道 革兰阴性杆菌 耐药 老年人 

分 类 号：R446.5[医药卫生—诊断学]