老年普外科住院患者相关性肺炎多重耐药菌感染的病原学诊断及临床治疗

摘要

目的：分析多重耐药菌感染在老年普外科住院患者相关性肺炎患者中病原学及抗菌药物治疗的耐药率，为临床诊断治疗提供依据。方法：采集医院372例老年普外科住院患者相关性肺炎患者痰液，进行痰培养及药敏试验，探讨其病原菌分布及抗菌药物治疗的耐药率分析。结果：372株病原菌中革兰氏阳性球菌95株，占15.32％；革兰氏阴性杆菌277株，占59.95％；真菌54株，占14.51％；其中常见的革兰氏阳性球菌包括金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌，分别占15.32％、2.96％、4.30％；常见的革兰氏阴性杆菌包括铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌，分别占23.92％、14.25％、9.95％；金黄色葡萄球菌对青霉素、红霉素、苯唑西林耐药率为100.00％，表皮葡萄球菌对红霉素耐药率最高87.50％，溶血葡萄球菌对青霉素、红霉素耐药率最高100.00％，三种主要革兰氏阴性杆菌均对替考西林和万古霉素耐药率最低0％；大肠埃希菌对头孢曲松、替卡西林耐药率最高100.00％，对环丙沙星耐药率最低11.32％；铜绿假单胞菌对头孢曲松耐药率最高100.00％，对亚胺培南耐药率最低22.47％；肺炎克雷伯菌对氨曲南耐药率最高81.08％，对亚胺培南最低0.00％。结论：老年普外科住院患者相关性肺炎患者在临床较为常见，按照其病原学分布及耐药性特点，进行抗菌药物的早期合理选用，同时做好相关的积极防治措施。%Objective:To analyze the etiology and the antimicrobial resistance rate of multi-drug re-sistant infection in elderly inpatients with associated pneumonia in the department of general surgery,so as to provide reference for clinical diagnosis and treatment. Methods:Sputum samples were collected from 372 elderly inpatients with associated pneumonia in the department of general surgery for sputum culture and sensi-tivity test to investigate the distribution of pathogens and the resistance rate to antimicrobial treatment. Re-sults:Among the 372 pathogens,there were 95 strains of gram-positive cocci,accounting for 15.32%;277 strains of gram-negative bacilli,accounting for 59.95%;54 strains of fungi,accounting for 14.5 1%. The common gram-positive cocci included Staphylococcus aureus,hemolytic Staphylococcus aureus,and Staphy-lococcus epidermidis,accounting for 15.32%,2.96%,and 4.30%. The common gram-negative bacteria included Pseudomonas aeruginosa,Escherichia coli,and Klebsiella pneumoniae,accounting for 23.92%,14.25%,and 9.95%. The resistance rate of Staphylococcus aureus to penicillin,erythromycin, benzene cloxacillin was 100.00%. The resistance rate of Staphylococcus epidermidis to erythromycin was up to 87.50%,and that of hemolytic Staphylococci to penicillin and erythromycin was up to 100.00%. Three major gram-negative bacilli showed the lowest resistance of 0%to Teicocillin. Escherichia coli had the high-est resistance rate of 100.00%to ceftriaxone and ticarcillin and the lowest resistance rate of 1 1.32%to cipro-floxacin. Pseudomonas aeruginosa had the highest resistance rate of 100.00%to ceftriaxone and the lowest re-sistance rate of 22.47%to imipenem. Klebsiella pneumoniae had the highest resistance rate of 8 1.08%to az-treonam and the lowest resistance rate of 0.00% to imipenem. Conclusion:Associated pneumonia is com-monly seen in elderly patients in the department of general surgery. Early rational use of antimicrobial drugs should be conducted for these patients according to pathogen distribution and drug resistance characteristics, meanwhile,relevant positive control measures should be taken.