老年肺部感染患者病原菌耐药性分析及治疗策略  

Drug resistance of pathogens causing pulmonary infections in the elderly and treatment strategies

作　　者：王玫红[1] 怀丽梅[1] 赵鑫亮[1] 

机构地区：[1]齐齐哈尔医学院附属三院呼吸内科,黑龙江齐齐哈尔161002

出　　处：《中华医院感染学杂志》2013年第2期298-300,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析老年肺部感染患者病原菌分布,探讨细菌耐药性及治疗策略,旨在为临床合理用药提供参考依据。方法采集2010年12月-2011年12月在医院住院治疗的121例老年肺部感染患者痰标本,将其送细菌分离培养、鉴定,并做药物敏感试验。结果 121例老年肺部感染患者送取的痰标本检出149株病原菌,以鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌及大肠埃希菌为主,分别占21.48%、16.11%、14.77%及12.08%;33株革兰阳性菌对青霉素、红霉素、四环素、环丙沙星的耐药率分别为87.88%、84.85%、81.82%、75.76%,对阿奇霉素、阿莫西林/克拉维酸、头孢哌酮/舒巴坦、亚胺培南/西司他丁敏感,耐药率分别为6.06%、3.03%、3.03%、3.03%;114株革兰阴性菌对头孢唑林、头孢哌酮、环丙沙星、头孢他啶的耐药率分别为97.37%、88.60%、86.84%、69.30%,而对阿莫西林/克拉维酸、阿奇霉素、头孢哌酮/舒巴坦、亚胺培南/西司他丁敏感,耐药率分别为4.39%、3.51%、0.88%、0.88%。结论老年肺部感染以革兰阴性杆菌为主,对阿莫西林/克拉维酸、头孢哌酮/舒巴坦及亚胺培南/西司他丁较敏感,在痰培养及药物敏感试验结果报告之前经验性的使用上述药物,可有效控制患者的临床症状、改善患者的预后。OBJECTIVE To probe into the pathogens causing pulmonary infections in the elderly, to explore the bacterial resistance and the treatment strategies so as to provide basis for the clinical reasonable use of antibiotics. METHODS We collected sputum specimens from old patients with pulmonary infections who were treated in the hospital from Dec 2010 to Dec 2011, then sent them for the bacterial culture and identification and carried out the drug susceptibility testing. RESULTS A total of 149 strains of pathogens were isolated from the 121 elderly patients with pulmonary infections, among which Acinetobacter baumanii, Pseudomonas aeruginosa, Staphylo- coccus aureus and Escherichia coli were the most common species, accounting for 21.48 %, 16.11%, 14.77 %, and 12.08%, respectively. The drug resistance rates of 33 strains of gram-positive bacteria to penicillin, erythromycin, tetracycline, and ciprofloxacin were 87. 88%, 84. 85%, 81. 82%, and 75. 76 %, respectively; the drug resistance rates to azithromycin, amoxicillin-clavulanate potassium, cefoperazone-sulbactam, and imipenem- cilastatin were 6.06%, 3.03%, 3.03%, and 3. 03%, respectively. The drug resistance rates of 114 strains of gram-negative bacteria to cefazolin, cefoperazone, ciprofloxacin, and ceftazidime were 97.37 %, 88.60 %, 86.84 %, and 69.30%, respectively; they were sensitive to amoxicillin-clavulanate potassium, azithromycin, cefoperazone- sulbactam, and imipenem-cilastatin, the drug resistance rates were 4. 39%, 3. 51%, 0. 88%, and 0. 88%, respectively. CONCLUSION The gram-negative bacteria are the main pathogens causing pulmonary infections in the elderly patients, which are highly sensitive to amoxicillin-clavulanate potassium, cefoperazone-sulbactam, and imipenem-cilastatin. Therefore, it is effective to control the clinical symptoms of the patients and improve the prognosis through the empirical use of the antibiotics before the results of sputum culture and drug susceptibility testing come out.

关 键 词：肺部感染 病原菌 耐药 治疗策略 

分 类 号：R181.32[医药卫生—流行病学]