老年下呼吸道感染患者的病原菌分布及耐药特点分析

摘要

Objective To investigate the correlation of lower respiratory tract infection pathogens distri-bution and drug resistance characteristics in the elderly patients.Methods From Jul.2012 to Jul.2014, sputum samples of elderly patients with lower respiratory tract infection from Renmin Hospital of Wuhan Uni-versity were collected and inoculated on blood agar plates and chocolate plates ,and suspected colonies were picked and tested using BD PhoenixTM 100 automated bacterial identification system.Results The detected pathogenic microorganisms were mainly Gram-negative bacill ( 75.8%) , including Klebsiella pneumoniae (25.2%),Pseudomonas aeruginosa(14.2%),Escherichia coli(13.4%) and Acinetobacter baumannii (7.8%).Klebsiella pneumoniae and Escherichia coli were most sensitive to carbapenems,and theresistance rate was less than 2%,Pseudomonas aeruginosa resistance rate to piperacillin /tazobactam was 17%,Acine-tobacter baumannii resistance rateswere all greater than 53%;Gram-positive cocci detection rate ( 18.0%) followed,including Staphylococcus aureus(10.3%) and Staphylococcus epidermidis(3.7%) most common, their resistant rate to penicillin were above 70%,but they were not resistant to vancomycin and teicoplanin;there were some fungal (6.3%),mainly including Candida albicans(3.7%).Conclusion Strengthening the detection of pathogenic microorganisms of lower respiratory tract infections in elderly patients , has great significance for guiding the rational use of antibiotics and the prevention and control of drug-resistant strains.%目的：探讨老年下呼吸道感染患者病原菌分布及耐药特点情况。方法收集2012年7月至2014年7月武汉大学人民医院老年下呼吸道感染患者的痰标本，接种于血琼脂平皿及巧克力平皿上并挑取可疑菌落采用BD PhoenixTM 100全自动细菌鉴定药敏系统进行检测。结果检出的病原微生物以革兰阴性杆菌（75．8％）为主，其中主要为肺炎克雷伯杆菌（25．2％）、铜绿假单胞菌（14．2％）、大肠埃希菌（13．4％）、鲍曼不动杆菌（7．8％）；肺炎克雷伯杆菌和大肠埃希菌对碳青霉烯类抗生素最敏感，耐药率小于2％，铜绿假单胞菌对哌拉西林／他唑巴坦的耐药率最低为17％，鲍曼不动杆菌的耐药率均高于53％。革兰阳性球菌检出率（18．0％）次之，其中以金黄色葡萄球菌（10．3％）、表皮葡萄球菌（3．7％）最常见，它们对青霉素耐药率均在70％以上，但它们没有出现对万古霉素和替考拉宁耐药。有部分真菌检出（6．3％），主要以白色念珠菌（3．7％）为主。结论加强老年下呼吸道感染患者的病原微生物的检测，对指导临床合理使用抗生素以及耐药菌株的预防与管控具有重要意义。