老年慢性充血性心力衰竭患者下呼吸道感染的病原菌分布及药敏分析  

Distribution and drug susceptibility of pathogens causing lower respiratory tract infections in elderly patients with chronic congestive heart failure

作　　者：卢世文[1] 李峥[2] 柳明波[3] 

机构地区：[1]钦州市第一人民医院心血管内科,广西钦州535000 [2]钦州市第一人民医院重症医学科,广西钦州535000 [3]钦州市第一人民医院检验科,广西钦州535000

出　　处：《中华医院感染学杂志》2015年第1期55-57,共3页Chinese Journal of Nosocomiology

基　　金：广西省卫生厅重点基金项目(GW-2010B-017)

摘　　要：目的探讨慢性充血性心力衰竭(CHF)合并下呼吸道感染的病原菌分布及药敏率,为临床正确选用抗菌药物治疗感染提供指导。方法选取慢性充血性心力衰竭合并下呼吸道感染老年患者86例,采用VITEK-32微生物鉴定系统进行菌株鉴定,同时进行痰培养药敏试验。结果共分离出病原菌216株,其中革兰阴性菌95株占43.98%,革兰阳性菌78株占36.11%,真菌43株占19.91%;革兰阳性菌对万古霉素、替考拉宁、亚胺培南的敏感性高,对青霉素、氨苄西林、氧氟沙星和阿奇霉素的敏感性低;革兰阴性菌对美罗培南、氨苄西林、亚胺培南和头孢唑林的敏感性高,而对氨曲南、头孢噻肟、阿米卡星的敏感性低;真菌对氟康唑、酮康唑、伏立康唑和伊曲康唑的敏感性极高,均为100.0%。结论革兰阴性菌为慢性充血性心力衰竭合并下呼吸道感染的主要致病菌,革兰阳性菌所占比例有所降低,真菌感染比例有所上升;革兰阴性菌和革兰阳性菌对抗菌药物的敏感性均有所下降,应根据药敏试验合理选用临床抗菌药物。OBJECTIVE To explore the distribution and drug susceptibility rates of the pathogens causing lower re-spiratory tract infections in elderly patients with chronic congestive heart failure so as to provide guidance for rea-sonable clinical use of antibiotics for treatment of infections.METHODS A total of 86 elderly patients with chronic congestive heart failure complicated with lower respiratory tract infections were enrolled in the study,the strains were identified by using VITEK microorganism identification system,meanwhile,the sputum culture and the drug susceptibility testing were performed.RESULTS Totally 216 strains of pathogens have been isolated,including 95 （43.98%）strains of gram-negative bacteria,78 （36.11%）strains of gram-positive bacteria,and 43 （19.91%） strains of fungi.The gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and imipenem, while the drug susceptibility rates to penicillin,ampicillin,ofloxacin,and azithromycin were low;the gram-nega-tive bacteria were highly susceptible to meropenem,ampicillin,imipenem,and cefazolin,while the drug suscepti-bility rates to aztreonam,cefotaxime,and amikacin were low;the drug susceptibility rates of the fungi to flucon-azole,ketoconazole,voriconazole,and itraconazole were as high as 100.0%.CONCLUSION The gram-negative bacteria are the predominant pathogens causing lower respiratory tract infections in the elderly patients with chron-ic congestive heart failure,the proportion of the gram-positive bacteria is decreased,and the proportion of the ca-ses of fungal infections is increased.The drug susceptibility rates of the gram-negative bacteria and the gram-posi-tive bacteria show a downward trend,and it is necessary to reasonably use antibiotics based on the drug suscepti-bility testing.

关 键 词：慢性充血性心力衰竭 下呼吸道感染 革兰阴性菌 革兰阳性菌 药敏试验 

分 类 号：R378[医药卫生—病原生物学]