门诊老年患者呼吸道感染的耐药性监测及影响因素分析  

Monitoring of drug resistance of pathogens causing respiratory tract infections in elderly patients of outpatient department and analysis of influencing factors

作　　者：周梅 刘芬 肖健[2] 

机构地区：[1]莱芜市滨河花苑社区卫生服务站,山东莱芜271100 [2]莱芜市人民医院医院感染科,山东莱芜271199

出　　处：《中华医院感染学杂志》2014年第2期374-376,共3页Chinese Journal of Nosocomiology

基　　金：莱芜市卫生局医学基金项目(鉴字2010-117)

摘　　要：目的分析门诊老年患者呼吸道感染的主要病原菌及药物敏感性,对治疗的影响因素进行分析,为门诊治疗提供参考。方法选择医院2012年3月-2013年3月门诊呼吸道感染的老年患者230例,取痰液与咽分泌物进行细菌培养,用K-B纸片法对药物敏感性进行测定,根据治疗与预后情况分组,将患者分为门诊治愈组162例与加重住院组68例,对两组患者的临床资料进行对比分析,探讨影响其治疗结果的因素。结果老年患者共培养出病原菌132株,阳性率为57.39%,以革兰阳性球菌为主,占75.00%,其次为革兰阴性球菌和真菌,分别占22.73%和2.27%;门诊病原菌的耐药性日趋严重,病原菌的耐药性日趋严重,对青霉素、氨苄西林耐药率大多>80.00%,革兰阴性菌对妥布霉素、红霉素、左氧氟沙星高度耐药,对头孢类抗菌药物较敏感,对亚胺培南高度敏感,革兰阳性菌对万古霉素高度敏感;影响预后的主要因素是合并糖尿病、合并肺部疾病、年龄>70岁、营养不良与白细胞计数、血钾及血红蛋白降低(P<0.05)。结论门诊老年患者呼吸道感染以革兰阳性菌为主,多数病原菌对头孢类抗菌药物敏感,影响预后的因素较多,治疗时应引起重视。OBJECTIVE To analyze the main species of pathogens causing respiratory tract infections in elderly pa- tients of outpatient department and the drug susceptibility and observe the influencing factors for treatment so as to guide the outpatient treatment. METHODS Totally 230 elderly patients with respiratory tract infections, who were treated in the Outpatient department from Mar 2012 to Mar 2013, were enrolled in the study, then the sputum and pharyngeal secretions were sampled for bacterial culture, the drug susceptibility testing was performed with the use of K-B method; the subjects, according to the treatment and prognosis, were divided into the cure group with 162 cases and the exacerbation and hospitalization group with 68 cases; the clinical data were analyzed and com- pared between the two groups, and the influencing factors for the clinical outcomeswere explored. RESULTS A to- tal of 132 strains of pathogens have been isolated from the elderly patients with the positive rate of 57.39% ,among which the gram-positive cocci accounted for 75.00%, the gram-negative bacteria 22.73%, the fungi 2.27%. The drug resistance of the pathogens was increasingly serious; the drug resistance rates to penicillin and ampicillin were more than 80.00 % ; the gram-negative bacteria were highly resistant to tobramycin, erythromycin, and levofloxa- cin but were susceptible to cephalosporin, highly susceptible to imipeneml the gram-positive bacteria were highly susceptible to vancomycin. The main influencing factors for the prognosis included the complication of diabetes, complication of pulmonary diseases, more than 70 years of age, malnutrition, low levels of white blood cell counts and serum potassium, and elevated level of hemoglobin. CONCLUSION The gram-positive bacteria are the predomi-nant pathogens causing respiratory tract infections in the elderly patients of outpatient department, most of the pathogens are susceptible to the cephalosporins; there are a variety of influencing factors for the clinical outcomes, which sho

关 键 词：门诊 老年患者 呼吸道感染 耐药性监测 影响因素 

分 类 号：R978.1[医药卫生—药品]