老年冠心病患者医院感染病原学特点及耐药性分析  

Pathogenic characteristics and drug resistance of nosocomial infections in elderly patients with coronary heart disease

作　　者：李炯[1] 冯倩[1] 邹艳红[1] 冯霞[1] 张俊娜[1] LI Jiong FENG Qian ZOU Yan-hong FENG Xia ZHANG Jun-na(Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China)

机构地区：[1]重庆市中医院呼吸科,重庆400021

出　　处：《中华医院感染学杂志》2017年第20期4678-4680,4696,共4页Chinese Journal of Nosocomiology

基　　金：重庆市卫计委基金资助项目(2014-2-072)

摘　　要：目的探讨老年冠心病患者医院感染的病原菌分布及耐药性。方法选取2014年12月-2016年2月医院诊治的216例老年冠心病医院感染患者的资料进行分析,采集患者痰液、血液及分泌物进行病原菌培养,采用最小抑菌浓度(MIC)法进行体外药敏试验,分析老年冠心病医院感染患者病原菌分布及耐药性,根据病原菌耐药性情况提出相应的解决对策。结果老年冠心病患者医院感染部位以呼吸道、尿路、胃肠道为主;216例老年冠心病医院感染中共分离出234株病原菌,其中革兰阴性菌138株占58.97%,以铜绿假单胞菌和大肠埃希菌为主;革兰阳性菌61株占26.07%,以金黄色葡萄球菌和表皮葡萄球菌为主;真菌35株占14.96%,以白色假丝酵母菌和曲霉菌属为主;铜绿假单胞菌对氨苄西林/舒巴坦、哌拉西林、头孢曲松及头孢他啶耐药率较高,均为78.26%;大肠埃希菌对阿莫西林/克拉维酸和哌拉西林耐药率较高,均为81.48%。金黄色葡萄球菌和表皮葡萄球菌对环丙沙星和红霉素耐药率较高,分别为54.84%、51.61%和44.44%、55.56%。结论老年冠心病医院感染病原菌主要以革兰阴性菌为主,且耐药性较高,应选择敏感抗菌药物进行治疗,提高治愈率。OBJECTIVE To investigate the distribution and drug resistance of nosocomial infections in elderly patients with coronary heart disease（CHD）.METHODS Clinical data of 216 cases of hospitalized patients with coronary heart disease from Dec.2014 to Feb.2016 were analyzed.The sputum,blood and secretions of the patients were collected for pathogen cultures.The method of MIC test was used to analyze the distribution and drug resistance of pathogens in elderly patients with coronary heart disease,and the corresponding countermeasures were put forward according to the drug resistance of pathogenic bacteria.RESULTS The infection sites of nosocomial infections in elderly patients with coronary heart disease were respiratory tract,urinary tract and gastrointestinal tract.Totally 234 strains of pathogens were isolated.Among them,138 strains were gram-negative bacteria,accounting for 58.97%,which were mainly Pseudomonas aeruginosaand Escherichia coli,61 strains were gram-positive bacteria,accounting for 26.07%,which were mainly Staphylococcus aureus and Staphylococcus epidermidis,and 35 strains were fungi,accounting for 14.96%,which were mainly Candida albicans and Aspergillus.The resistant rates of P.aeruginosa to ampicillin/sulbactam,piperacillin,ceftriaxone and ceftazidime were relatively high,which were all 78.26%.The resistant rates of E.coli to amoxicillin/clavulanic acid and piperacillin were relatively high,which were 81.48%.The resistant rates of S.aureus and S.epidermidis to ciprofloxacin and erythromycin were relatively high,which were 54.84%,51.61% and 44.44%,55.56%.CONCLUSION The main pathogens of nosocomial infection in elderly patients with coronary heart disease are gram-negative bacteria,and the drug resistant rates are high,so we should select sensitive antibiotics,so as to improve clinical cure rate.

关 键 词：老年冠心病患者 医院感染 病原菌分布 耐药性 

分 类 号：R654.2[医药卫生—外科学]