老年病区常见病原菌构成及其耐药性变迁

摘要

目的：分析老年病区分离的常见病原菌构成及其耐药性变迁，为临床合理使用抗菌药物提供参考。方法分析2009—2013年某院老年病区住院患者送检标本，对检出病原菌及耐药情况进行统计分析。结果2009—2013年共检出病原菌7426株，其中革兰阴性（G－）杆菌6755株（占90．96％），革兰阳性（G＋）球菌537株（占7．23％），真菌134株（占1．81％）。检出菌株数居前5位的依次为铜绿假单胞菌（39．16％）、大肠埃希菌（16．47％）、嗜麦芽窄食单胞菌（10．65％）、肺炎克雷伯菌（7．22％）及鲍曼不动杆菌（6．21％），居前5位的细菌标本来源主要为痰（5573株，占94．15％）。鲍曼不动杆菌对检测的所有抗菌药物耐药率均呈上升趋势（均P ＜0．01）；铜绿假单胞菌对哌拉西林／他唑巴坦、头孢他啶、氨曲南、亚胺培南等8种常见抗菌药物，以及大肠埃希菌对哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、氨曲南、左氧氟沙星及环丙沙星5种常见抗菌药物的耐药率均呈上升趋势（均P ＜0．01）；肺炎克雷伯菌对检测的所有抗菌药物耐药率均无明显变化（均 P ＞0．05）。嗜麦芽窄食单胞菌对头孢他啶和左氧氟沙星的耐药率呈上升趋势（均 P ＜0．01）。结论老年病区分离的病原菌以铜绿假单胞菌为主，其对多种常见抗菌药物耐药率高，且日趋严重，临床应根据药敏试验结果合理选用抗菌药物。%Objective To analyze the distribution and change of antimicrobial resistance of common pathogenic bacteria from geriatric ward,and provide reference for rational use of antimicrobial agents.Methods Specimens from hospitalized patients in a geriatric ward from 2009 to 2013 were analyzed,the isolated pathogenic bacteria and antimicrobial resistance of bacteria were analyzed statistically.Results From 2009 to 2013,a total of 7 426 patho-genic bacteria were isolated,the percentage of gram-negative bacilli,gram-positive cocci,and fungi were 90.96%(n=6 755),7.23%(n =537),and 1 .81 % (n = 134),respectively.The top 5 detected bacteria were Pseudomonas aeruginosa (39.16%),Escherichia coli (16.47%),Stenotrophomonas maltophilia (10.65%),Klebsiella pneu-moniae (7.22%),and Acinetobacter baumannii (6.21 %),these strains were mainly isolated from sputum (94.15%,n =5 573 ).Resistance rates of Acinetobacter baumannii to all detected antimicrobial agents,Pseudo-monas aeruginosa to 8 kinds of common antimicrobial agents (piperacillin / tazobactam,ceftazidime,aztreonam, imipenem,et al),Escherichia coli to 5 kinds of common antimicrobial agents (piperacillin/ tazobactam,cefopera-zone/sulbactam,aztreonam,levofloxacin,and ciprofloxacin),and Stenotrophomonas maltophilia to ceftazidime and levofloxacin all showed an increased tendency (all P <0.01 );there was no obvious change in resistance rates of Klebsiella pneumoniae to all detected antimicrobial agents (all P >0.05).Conclusion The major pathogenic bacteria isolated from geriatric ward is Pseudomonas aeruginosa ,which is highly resistant to multiple antimicrobial agents, antimicrobial agents should be chosen based on antimicrobial susceptibility testing results.