老年卒中相关性肺炎患者病原菌分布与耐药性分析  

Analysis of distribution and drug resistance of pathogens in patients with senile stroke-associated pneumonia

作　　者：陆媛[1] 徐金富[1] 梁兴伦[1] 蒋卫民[1] 

机构地区：[1]同济大学附属杨浦医院老年科,上海200090

出　　处：《中华医院感染学杂志》2015年第3期537-539,共3页Chinese Journal of Nosocomiology

基　　金：上海市曙光计划基金资助项目(13SG21)

摘　　要：目的探讨老年卒中相关性肺炎患者的痰液病原菌分布及其对抗菌药物耐药性特点,为临床早期治疗提供依据。方法对2010年1月-2012年12月住院的260例老年卒中相关性肺炎患者痰液标本检验结果进行回顾性研究,分析病原菌分布及其对抗菌药物的耐药率特点,细菌鉴定采用法国生物梅里埃公司VITEK-32鉴定系统,药物敏感试验采用K-B药敏纸片扩散法进行,药敏结果判断标准按照美国临床实验室标准化委员会(NCCLS)2002年版临床标准,数据采用SPSS20.0软件进行统计分析。结果 260例老年卒中相关性肺炎患者痰液标本中共分离出病原菌308株,其中革兰阴性菌252株占81.82%,革兰阳性菌29株占9.41%,真菌27株占8.77%;前6位病原菌分别为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、阴沟肠杆菌及金黄色葡萄球菌,分别占22.08%、16.56%、10.71%、10.39%、7.14%、7.14%;革兰阴性菌对头孢他啶、头孢呋辛、头孢西丁等常用抗菌药物耐药率均>50.00%,革兰阳性菌对万古霉素、替考拉宁、利福平耐药率较低。结论老年卒中相关性肺炎患者感染病原菌菌以革兰阴性菌为主,且多药耐药日趋严重,根据抗菌药物耐药性特点提供对老年卒中相关性肺炎患者的早期经验用药,指导和加强抗菌药物的规范使用。OBJECTIVE To investigate distribution and characteristics of antibiotic resistance of sputum pathogens for senile stroke-associated pneumonia （SAP） to provide the reference for early clinical treatment. METHODS The clinical data of 260 senile SAP patients in our hospital from Jan. 2010 to Dec. 2012 were reviewed. The distribution and antibiotic sensitivity of pathogens isolated from the cultured sputum collected from the patients were analyzed. The pathogen identification was conducted with the VITEK-32 identification system （Biomerieux Co. Ltd., France）, and the drug sensitivity testwas conducted with the K-B disk diffusion method. The evaluation of sensitivity results was conducted with reference of the clinical criteria （2002 version） by NCCLS. Data were statistically analyzed by the software SPSS 20.0. RESULTS A total of 308 strains of pathogens were isolated including 252 strains （81.81 %） of gram-negative bacteria, 29 strains （9.41 % ） of gram-positive bacteria and 27 strains （8. 770/4o） of fungi. The pathogens ranking top six were Klebsiella Pneumoniae （22.08 %）, Pseud- omonas aeruginosa （16. 56%）, Acinetobacter baumannii （10. 71%）, Escherichia coli （10. 39 % ） , Enterobacter cloacae （7.14 %） and Staphylococcus aureus （7.14 %）. The resistance of gram-negative bacteria to common used drugs such as ceftazidime, cefuroxime and cefoxitin were above 50.0%. Gram-positive bacteria had relatively low resistance to vancomyein, teieoplanin and rifampin. CONCLUSION Gram-negative bacteria are the major pathogens for senile SAP and have an increasing trend of multiple drug resistance. The clinical doctors should take advantage of these resistance characteristics and reasonably choose the sensitive antibiotics for patients with senile SAP according to the test results of pathogen sensitivity to drugs.

关 键 词：老年患者 卒中相关性肺炎 痰液 耐药性 

分 类 号：R378[医药卫生—病原生物学]