老年肺部感染患者病原菌耐药性及凝血、纤维溶解指标变化  

Drug Resistance of Pathogenic Bacteria and Changes of Coagulation and Fibrinolysis Indexes in Elderly Patients with Pulmonary Infection

作　　者：郑运周[1] 侯天文 张会峰[1] 高鹏[1] 米明强 李亚娟[1] 宋静静 ZHENG Yun-zhou;HOU Tian-wen;ZHANG Hui-feng;GAO Peng;MI Ming-qiang;LI Ya-juan;SONG Jing-jing(Department of Laboratory Medicine,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China;Department of Laboratory Medicine,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050011,China)

机构地区：[1]解放军联勤保障部队第九八〇(白求恩国际和平)医院检验实验科,石家庄050082 [2]河北省中医院检验科,石家庄050011

出　　处：《临床误诊误治》2021年第9期61-66,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2017年重点科技研究计划(20170965)。

摘　　要：目的探讨老年肺部感染患者病原菌耐药性及凝血、纤维溶解指标变化。方法选取2019年1月—2020年10月住院的老年肺部感染410例,根据痰培养结果将其中细菌感染35例作为细菌组,真菌感染14例作为真菌组;另选取同期老年健康体检者40例作为对照组。分析老年肺部感染患者病原菌分布、构成比及耐药性,比较细菌组、真菌组和对照组凝血和纤维溶解指标。结果老年肺部感染410例中病原菌检出率为65.12%,共检出病原菌428株,其中革兰阴性菌321株,革兰阳性菌24株,真菌83株。老年肺部感染患者肺炎克雷伯菌耐药率从高到低依次是阿莫西林-克拉维酸钾、氨苄西林钠-舒巴坦钠和头孢唑啉钠等,铜绿假单胞菌耐药率从高到低依次是替卡西林钠-克拉维酸钾、哌拉西林钠和庆大霉素等,嗜麦芽寡养单胞菌耐药率从高到低依次是头孢他啶、氯霉素和左氧氟沙星等,黏质沙雷菌耐药率从高到低依次是头孢噻肟、莫西沙星和庆大霉素等;金黄色葡萄球菌耐药率从高到低依次是青霉素、红霉素、克拉霉素和阿奇霉素等;白色念珠菌耐药率从高到低依次是卡泊芬净、伊曲康唑和氟康唑。细菌组和真菌组凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、D-二聚体和纤维蛋白原降解产物长于或高于对照组,抗凝血酶Ⅲ低于对照组;细菌组血小板(PLT)和血小板压积(PCT)高于真菌组和对照组,真菌组PLT和PCT低于对照组,差异有统计学意义(P<0.05或P<0.01)。结论老年肺部感染患者病原菌以革兰阴性菌为主,临床应结合药敏试验结果合理选用抗生素;若患者凝血和纤维溶解指标异常,应早期采取干预措施。Objective To investigate drug resistance of pathogenic bacteria and changes of coagulation and fibrinolysis indexes in elderly patients with pulmonary infection.Methods A total of 410 elderly patients with pulmonary infection admitted between January 2019 and October 2020 were selected.According to results of sputum culture,35 cases of bacterial infection and 14 cases of fungal infection were selected as bacterial group and fungal group respectively;another 40 elderly healthy people who had undergone physical examination at the same period were selected as control group.Conditions of distribution,constituent ratio and drug resistance of pathogens in elderly patients with pulmonary infection were analyzed,and the coagulation and fibrinolysis indexes were compared among bacteria,fungi and control groups.Results Among 410 elderly patients with pulmonary infection,the detection rate of pathogenic bacteria was 65.12%,and 428 strains of pathogenic bacteria were detected,which included 321 strains of Gram-negative bacteria,24 strains of Gram-positive bacteria and 83 strains of fungi.The drug resistance rates of Klebsiella pneumoniae in elderly patients with pulmonary infection from high to low were Amoxicillin Clavulanate Potassium,Ampicillin Sulbactam Sodium and Cefazolin Sodium in turns.The drug resistance rates of Pseudomonas Aeruginosa from high to low were Ticarcillin Clavulanate Potassium,Piperacillin Sodium and Gentamycin in turns.The drug resistance rates of Stenotrophomonas Maltophilia from high to low were Ceftazidime,Chloramphenicol and Levofloxacin in turns.The drug resistance rates of Serratia Marcescens from high to low were Cefotaxime,Moxifloxacin and Gentamicin in turns.The drug resistance rate of Staphylococcus Aureus from high to low was Penicillin,Erythromycin,Clarithromycin and Azithromycin in turns.The drug resistance rate of Candida Albicans from high to low was Caspofungin,Itraconazole and Fluconazole in turns.Compared with those in control group,prothrombin time,activated partial thromboplastin t

关 键 词：感染 肺 老年人 病原菌 肺炎克雷伯菌 铜绿假单胞菌 白色念珠菌 耐药性 凝血酶原时间 纤维蛋白原 

分 类 号：R563.1[医药卫生—呼吸系统]