老年重症肺炎行机械通气患者病原菌分布及耐药率分析  

Distribution of pathogenic bacteria and drug resistance in senile patients with severe pneumonia receiving mechanical ventilation

作　　者：陆卫华[1] 杨剑虹[1] 方庆[1] 李刚[1] 唐忠志[1] 

机构地区：[1]广州军区武汉总医院急诊科,武汉430070

出　　处：《西南国防医药》2013年第4期372-374,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨老年重症肺炎并行有创机械通气患者的病原菌分布及其耐药率,为临床合理应用抗生素提供参考。方法采用支气管镜深部吸痰收集标本,检测108例老年重症肺炎并行有创机械通气患者的致病菌及对抗菌药物的耐药率。结果 108例细菌培养阳性率为81.50%。共检出致病菌92株,其中G-杆菌68株(73.90%),主要为肺炎克雷伯杆菌(25.00%)、铜绿假单胞菌(19.60%)、鲍曼不动杆菌(13.00%)、阴沟肠杆菌(6.50%)、大肠埃希菌(4.30%);真菌14株(15.20%);G+菌10株(10.90%)。G-菌主要对多粘菌素、亚胺培南、比阿培南、哌拉西林/他唑巴坦的耐药率较低;G+菌对万古霉素、替考拉宁、夫西地酸的耐药率较低;真菌的耐药率均低于30.00%。结论对于行机械通气的老年重症肺炎患者,G-菌是最主要的病原菌,其次是真菌和G+球菌,G-菌和G+菌具有较高的耐药率,真菌的耐药率较低。Objective To discuss the distribution of pathogenic bacteria and the drug resistance in senile patients with severe pneumonia who received mechanical ventilation, and to provide references for clinical reasonable use of antibiotics. Methods The sputum specimens were obtained by bronchoscope. Detection was made in the pathogenic bacteria and their drug resistance in 108 senile patients with severe pneumonia who received mechanical ventilation. Results Among the 108 cases, the positive rate of germicuhure was 81.50%. There were totally 92 strains of bacteria detected, among which 68 strains were G^- bacillus （73.90%）, including klebsiella pneumoniae （ 25. 00% ）, pseudomonas aeruginosa （ 19. 60% ）, acinetobacter baumannii （ 13. 00% ）, enterobacter cloacae （6.50%） ,escherichia coli（4.30% ）. There were 14 strains of fungi（ 15.20% ） and 10 strains of G^＋ bacillus（ 10.90% ）. G^- bacillus had lower drug resistance rate to polymyxin, imipenem, biapenem, and piperacillin/ tazobactam. The G^＋ bacillus had lower drug resistance to vancocin, teicoplanin, and fusidic acid. The drug resistance rates of fungi were all lower than 30.00%. Conclusion For senile patients with severe pneumonia receiving mechanical ventilation, the main pathogenic bacterium is G^- bacillus, and the next were fungi and G^＋ bacillus. The drug resistance rate of G^- bacillus and G ^＋ bacillus is higher, and that of fungi is lower.

关 键 词：老年 重症肺炎 机械通气 病原菌 耐药 

分 类 号：R563.1[医药卫生—呼吸系统]