帕金森病患者肺部感染病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens causing pulmonary infections in patients with Parkinson′s disease

作　　者：张冠壮[1] 黄宏敏[1] 卢瑞丽[1] 许玉皎[1] 刘德浪 

机构地区：[1]海南省中医院神经内科,海南海口570203

出　　处：《中华医院感染学杂志》2017年第10期2218-2220,2228,共4页Chinese Journal of Nosocomiology

基　　金：海南省中医药管理局基金资助项目(hn28123)

摘　　要：目的探讨帕金森病患者肺部感染临床漏诊原因,总结病原菌分布和耐药情况,以期降低漏诊和感染率。方法回顾性分析2011年1月-2013年1月86例帕金森病肺部感染患者,统计其病原菌分布和耐药性,并对其中漏诊的11例患者的漏诊原因进行总结。结果帕金森病肺部感染86例患者中共培养出病原菌107株,其中革兰阴性菌72株,占67.29%,革兰阳性菌35株,占32.71%;革兰阴性菌中铜绿假单胞菌占28.97%、大肠埃希菌占17.76%、阴沟肠杆菌占12.15%;革兰阳性菌中金黄色葡萄球菌占15.89%、肺炎链球菌占10.28%;革兰阴性菌对亚胺培南、美罗培南耐药率均为0,对其余抗菌药物的耐药率均>52.63%;革兰阳性菌对万古霉素耐药率为0,对其余抗菌药物的耐药率均>72.73%;在帕金森病肺部感染漏诊原因中以口服药物影响最常见,占36.37%,其他的主要是停药、用药不足或减药引起,占27.27%,误吸占18.18%,医师忽视占18.18%。结论帕金森病患者肺部感染病原菌较多,漏诊率高,原因多为主观性。OBJECTIVE To explore the causes of clinical missed diagnosis of pulmonary infections in patients with Parkinson＇s disease and observe the distribution and drug resistance of pathogens so as to reduce the missed diagnosis rate and infection rate.METHODS A total of 86 Parkinson＇s disease with pulmonary infections who were treated in the hospital from Jan 2011 to Jan 2013 were retrospectively analyzed.The distribution and drug resistance of the pathogens were statistically analyzed,and the causes of the missed diagnosis of 11 patients were summarized.RESULTS Totally 107 strains of pathogens were isolated from the 86 Parkinson＇s disease with pulmonary infection,including 72 （67.29 %） strains of gram-negative bacteria and 35 （32.71%） strains of gram-positive bacteria.Among the gram-negative bacteria,Pseudomonas aeruginosa accounted for 28.97%,Escherichia coli 17.76 %,Enterobacter cloacae 12.15 %.Among the gram-positive bacteria,Staphylococcus aureus accounted for 15.89 %,Streptococcus pneumoniae 10.28 %.The drug resistance rates of the gram-negative bacteria to imipenem and meropenem were 0,and the drug resistance rates to the rest of antibiotics were more than 52.63 %.The drug resistance rate of the gram-positive bacteria to vancomycin was 0,and the drug resistance rates to the rest of antibiotics were more than 72.73 %.The oral administration of drugs was the most common cause of missed diagnosis of pulmonary infection in the Parkinson＇s disease patients,accounting for 36.37%,followed by the withdrawal,insufficiency,or reduction of drugs （27.27%）,aspiration （18.18%）,and doctors＇ neglection （18.18%）.CONCLUSION There are a variety of species of pathogens causing the pulmonary infections in the patients with Parkinson＇s disease.The missed diagnosis rate is high,and most of the causes are subjective.

关 键 词：帕金森病 肺部感染 临床漏诊 

分 类 号：R563.1[医药卫生—呼吸系统]