老年下呼吸道感染铜绿假单胞菌的病原学特征分析  

Etiological characteristics of Lower respiratory tract infection in the elderly

作　　者：陈惠刚 李桂艳 马微 CHEN Huigang;LI Guiyan;MA Wei(Medical College of Zhangjiakou University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]张家口学院医学院,河北张家口075000

出　　处：《中国病原生物学杂志》2024年第1期74-78,共5页Journal of Pathogen Biology

摘　　要：目的分析本地区老年下呼吸道感染患者的病原学特征。方法选取2020-2022年张家口学院附属人民医院治疗的286例老年下呼吸道感染患者为研究对象,选取同期住院、年龄≥65岁未发生下呼吸道感染的住院患者为对照组。患者入院后未进行抗菌治疗前,采集清晨第一口痰液,接种不同培养基,培养分离纯化后用全自动细菌鉴定及药敏分析系统进行菌株鉴定及药敏分析,采用聚合酶链反应检测铜绿假单胞菌毒力基因的携带情况。结果286例老年下呼吸道感染患者中,主要为肺炎(49.65%,142/286),检出286株病原菌。212株为革兰阴性菌,主要为肺炎克雷伯菌(22.73%,22/286)和铜绿假单胞菌(14.69%,42/286)。72株为革兰阳性菌(25.17%,72/286),主要为肺炎链球菌(11.89%,34/286)。对革兰阴性菌进行药敏试验,对氨曲南、左氧氟沙星、复方新诺明的耐药率高于50%,分别为50.47%、53.77%和52.36%,对头孢他啶、莫西沙星的耐药率低于30%,分别为29.72%和24.53%,对亚胺培南、美罗培南、阿米卡星耐药率低于10%。对革兰阳性菌进行药敏试验,对青霉素、红霉素、克林霉素、复方新诺明的耐药率高于50%,分别为95.83%、72.22%、61.11%和55.56%,对莫西沙星的耐药率为26.39%,未产生对万古霉素、替考拉宁的耐药株。42株铜绿假单胞菌中,28株携带exoS基因(66.67%,28/42),11株携带exoU基因(26.19%,11/42)。携带exoU基因的铜绿假单胞菌,对环丙沙星、左氧氟沙星、莫西沙星、庆大霉素、阿米卡星的耐药率均高于携带exoS基因的铜绿假单胞菌,携带exoU基因的铜绿假单胞菌对氨曲南的耐药率低于携带exoS基因的铜绿假单胞菌,差异有统计学意义(P<0.05)。携带exoS基因与exoU基因的铜绿假单胞菌对头孢他啶、亚胺培南、美罗培南的耐药率均低于40%,对复方新诺明的耐药率均高于50%,差异无统计学意义(P>0.05)。对比三组患者血清PCT水平,细菌感染组患者高于Objective To analyze the pathogenic characteristics of elderly patients with Lower respiratory tract infection in this area.Methods 286 elderly patients with Lower respiratory tract infection who were treated in the Affiliated People's Hospital of Zhangjiakou University from January 1,2020 to December 31,2022 were selected as the subjects of this study.In addition,elderly inpatients who were hospitalized in the same period and whose age was≥65 years without Lower respiratory tract infection were selected as the control group.After the patient was admitted to the hospital and before receiving antibacterial treatment,the first morning sputum was collected.Qualified sputum samples were inoculated onto different culture media,and after cultivation,separation and purification,pathogen identification and drug sensitivity analysis were carried out by a fully automated bacterial identification and drug sensitivity analysis system.The carrying of virulence genes in the isolated Pseudomonas aeruginosa were detected by Polymerase Chain reaction.Results In 286 elderly patients with Lower respiratory tract infection,pneumonia was the main cause(49.65%,142/286),and 286 strains of pathogens were detected.212 strains were Gram negative bacteria,mainly Klebsiella pneumoniae(22.73%,22/286)and P.aeruginosa(14.69%,42/286).72 strains were Gram positive bacteria(25.17%,72/286),mainly Streptococcus pneumoniae(11.89%,34/286).The drug sensitivity test of gram-negative bacteria showed that the drug resistance rate to aztreonam,Levofloxacin and Trimethoprim/sulfamethoxazole was higher than 50%(50.47%,53.77%and 52.36%respectively),the drug resistance rate to Ceftazidime,and Moxifloxacin was lower than 30%(29.72%,and 24.53%respectively),and the drug resistance rate to Imipenem,Meropenem,and Amikacin was lower than 10%.The drug sensitivity test of Gram positive bacteria showed that the drug resistance rate to penicillin,Erythromycin,Clindamycin and Trimethoprim/sulfamethoxazole was higher than 50%,which were 95.83%,72.22%,61.11%and 55.56%,r

关 键 词：下呼吸道感染 病原菌 耐药性 铜绿假单胞菌 毒力基因 

分 类 号：R446.5[医药卫生—诊断学] R56[医药卫生—临床医学]