呼吸科病房老年病人肺部感染常见病原菌及其耐药性分析
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摘要
目的对老年病人(年龄≥65岁)肺部感染的常见病原菌及其耐药性进行分析,为临床预防和治疗老年肺部感染提供依据。方法回顾性收集中国医科大学附属盛京医院2013年1月至2015年12月老年病人感染的常见病原菌并对其耐药性进行分析。结果共分离出318株病原菌,其中革兰阴性杆菌295例,占92. 77%。其中鲍曼不动杆菌最多,占43. 71%;其次是铜绿假单胞菌和肺炎克雷伯杆菌,分别占16. 98%和12. 89%。共分离出革兰阳性球菌20例,占6. 29%。真菌3例,占0. 94%。不同病原菌耐药程度不同,其中鲍曼不动杆菌对青霉素类、头孢类抗生素耐药率达90%～100%,对氨基糖苷类抗生素耐药率亦达38%～90%,仅替加环素耐药率为10. 31%。铜绿假单胞菌耐药亦较严重。肺炎克雷伯杆菌耐药率相对乐观,临床可选药物较多。金黄色葡萄球菌对青霉素、头孢类抗生素几乎均耐药,对万古霉素、利奈唑胺、喹努普汀/达福普汀及替加环素最为敏感。结论老年肺部感染以革兰阴性杆菌为主,临床应根据药敏实验结果合理应用抗生素来更好地控制疾病和防止产生耐药菌。
Objective To provide firm evidence for prevention and treatment of pulmonary infection,we conducted a study to investigate the pathogen distribution and drug resistance in hospitalized elderly patients with pulmonary infection. Methods Data about common pathogens and antimicrobial resistance were collected and retrospectively analyzed in patients who were hospitalized for pulmonary infection from January 2013 to December 2015 in our hospital. Results Among the isolated 318 strains of pathogenic bacteria,295(92. 77%) were gram-negative bacilli. Acinetobacter baumannii,which is the most common gram-negative bacilli,accounts for 43. 71%of the total pathogens,followed by Pseudomonas aeruginosa and Klebsiella pneumoniae,making up 16. 98% and 12. 89% respectively of the total isolated pathogens. 20 gram-positive cocci and 3 Fungi in 318 strains of isolated pathogens,accounting for 6. 29% and 0. 94%respectively. The degree of resistance are different between different pathogens. The resistant rate of Baumannii to penicillin and cephalosporins is up to 90%-100%,to aminoglycosides is 38%-90%,while to tigecycline is only 10. 31%. Drug-resistance of Pseudomonas aeruginosa is severe as well,but resistance of Klebsiella bacillus is less severe,with more effective antibiotics available for clinical use.Staphylococcus aureus is almost resistant to penicillin and cephalosporins,while sensitive to vancomycin,linezolid,quinupristin/dalfopristin and tigecycline. Conclusion Gram-negative bacilli are the main pathogens of pulmonary infection in the elderly patients. To effectively control infection and prevent the emergence of drug resistance,antibiotics should be reasonably selected according to drug-sensitive test.
Objective To provide firm evidence for prevention and treatment of pulmonary infection,we conducted a study to investigate the pathogen distribution and drug resistance in hospitalized elderly patients with pulmonary infection. Methods Data about common pathogens and antimicrobial resistance were collected and retrospectively analyzed in patients who were hospitalized for pulmonary infection from January 2013 to December 2015 in our hospital. Results Among the isolated 318 strains of pathogenic bacteria,295(92. 77%) were gram-negative bacilli. Acinetobacter baumannii,which is the most common gram-negative bacilli,accounts for 43. 71%of the total pathogens,followed by Pseudomonas aeruginosa and Klebsiella pneumoniae,making up 16. 98% and 12. 89% respectively of the total isolated pathogens. 20 gram-positive cocci and 3 Fungi in 318 strains of isolated pathogens,accounting for 6. 29% and 0. 94%respectively. The degree of resistance are different between different pathogens. The resistant rate of Baumannii to penicillin and cephalosporins is up to 90%-100%,to aminoglycosides is 38%-90%,while to tigecycline is only 10. 31%. Drug-resistance of Pseudomonas aeruginosa is severe as well,but resistance of Klebsiella bacillus is less severe,with more effective antibiotics available for clinical use.Staphylococcus aureus is almost resistant to penicillin and cephalosporins,while sensitive to vancomycin,linezolid,quinupristin/dalfopristin and tigecycline. Conclusion Gram-negative bacilli are the main pathogens of pulmonary infection in the elderly patients. To effectively control infection and prevent the emergence of drug resistance,antibiotics should be reasonably selected according to drug-sensitive test.
引文
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[3]盛波,叶英,李家斌.住院病人70160例医院感染调查分析[J].安徽医药,2017,21(1):77-81.
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[9]NOGUCHI S,YATERA K,KAWANAMI T,et al.The clinical features of respiratory infections caused by the Streptococcus anginosus group[J].BMC Pulmonary Medicine,2015,15(1):133.
[10]蒋海平.老年患者革兰阴性杆菌性肺炎的菌群分布及耐药性[J].中华医院感染学杂志,2012,22(10):2209-2210.
[11]赵霞,张国伟.老年患者下呼吸道感染病原菌检验结果分析[J].基层医学论坛,2013(13):1714-1715.
[12]吴宗宝,李爱娟,丁式行,等.感染科呼吸内科住院患者感染病原菌分布及耐药性分析[J].浙江临床医学,2016,18(12):2321-2321.
[13]GORDON S B,BRUCE N G,GRIGG J,et al.Respiratory risks from household air pollution in low and middle income countries[J].Lancet Respir Med,2014,2(10):823-860.
[14]周蓉,朱卫民.肺炎克雷伯菌分子流行病学及耐药机制研究进展[J].国外医药抗生素分册,2012,33(1):1-5.
[15]BARTON R C,HOBSON R P,MCLOUGHLIN H,et al.Assessment of the significance of respiratory culture of Aspergillus,in the nonneutropenic patient.A critique of published diagnostic criteria[J].European Journal of Clinical Microbiology&Infectious Diseases,2013,32(7):923-928.
[16]AYDEMIR O,AYDEMIR Y,OZDEMIR M.The role of multiplex PCR test in identification of bacterial pathogens in lower respiratory tract infections[J].Pakistan Journal of Medical Sciences Online,2014,30(5):1011-1016.
[17]SHINDO Y,ITO R,KOBAYASHI D,et al.Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia.[J].American Journal of Respiratory&Critical Care Medicine,2013,188(8):985-995.
[18]SURESH B K,KASTELIK J,MORJARIA J B.Role of long term antibiotics in chronic respiratory diseases.[J].Respiratory Medicine,2013,107(6):800-815.
[19]俞云松.重视细菌耐药监测提高耐药监测水平[J].中华检验医学杂志,2012,35(1):6-7.
[20]WANG PH,WANG HC.Risk factors to predict drug-resistant pathogens in hemodialysis-associated pneumonia[J].BMC Infect Dis,2016,16(1):377.
[21]黄承龙,于锋,葛卫红,等.慢性阻塞性肺疾病急性加重期的病原菌分布与抗菌药物的应用分析[J].安徽医药,2015,19(6):1199-1201.
[2]HUOI C,VANHEMS P,NICOLLE M C,et al.Incidence of Hospital-Acquired Pneumonia,Bacteraemia and Urinary Tract Infections in Patients with Haematological Malignancies,2004-2010:A Surveillance-Based Study[J].Plos One,2013,8(3):e58121.DOI:10.1371/journal.pone.0058121.
[3]盛波,叶英,李家斌.住院病人70160例医院感染调查分析[J].安徽医药,2017,21(1):77-81.
[4]陈飞飞,王煦,何海照.老年肺部感染患者的病原菌分布及药物敏感性分析[J].现代实用医学,2016,28(9):1166-1167.
[5]MIRAVITLLES M,ANZUETO A.Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease[J].American Journal of Respiratory&Critical Care Medicine,2013,188(9):1052-1057.
[6]水跃翔,周华,朱丹,等.呼吸内科下呼吸道感染病原菌分布及耐药性分析[J].中国微生态学杂志,2014,26(8):900-902.
[7]于琦,修云霞,杨翠珍.老年呼吸道感染患者病原性细菌临床检验探讨[J].中国药物经济学,2013(4):295-296.
[8]周冰,奚艳,朱益文.老年人院内肺部感染及细菌耐药性分析[J].临床合理用药杂志,2011,4(36):185-186.
[9]NOGUCHI S,YATERA K,KAWANAMI T,et al.The clinical features of respiratory infections caused by the Streptococcus anginosus group[J].BMC Pulmonary Medicine,2015,15(1):133.
[10]蒋海平.老年患者革兰阴性杆菌性肺炎的菌群分布及耐药性[J].中华医院感染学杂志,2012,22(10):2209-2210.
[11]赵霞,张国伟.老年患者下呼吸道感染病原菌检验结果分析[J].基层医学论坛,2013(13):1714-1715.
[12]吴宗宝,李爱娟,丁式行,等.感染科呼吸内科住院患者感染病原菌分布及耐药性分析[J].浙江临床医学,2016,18(12):2321-2321.
[13]GORDON S B,BRUCE N G,GRIGG J,et al.Respiratory risks from household air pollution in low and middle income countries[J].Lancet Respir Med,2014,2(10):823-860.
[14]周蓉,朱卫民.肺炎克雷伯菌分子流行病学及耐药机制研究进展[J].国外医药抗生素分册,2012,33(1):1-5.
[15]BARTON R C,HOBSON R P,MCLOUGHLIN H,et al.Assessment of the significance of respiratory culture of Aspergillus,in the nonneutropenic patient.A critique of published diagnostic criteria[J].European Journal of Clinical Microbiology&Infectious Diseases,2013,32(7):923-928.
[16]AYDEMIR O,AYDEMIR Y,OZDEMIR M.The role of multiplex PCR test in identification of bacterial pathogens in lower respiratory tract infections[J].Pakistan Journal of Medical Sciences Online,2014,30(5):1011-1016.
[17]SHINDO Y,ITO R,KOBAYASHI D,et al.Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia.[J].American Journal of Respiratory&Critical Care Medicine,2013,188(8):985-995.
[18]SURESH B K,KASTELIK J,MORJARIA J B.Role of long term antibiotics in chronic respiratory diseases.[J].Respiratory Medicine,2013,107(6):800-815.
[19]俞云松.重视细菌耐药监测提高耐药监测水平[J].中华检验医学杂志,2012,35(1):6-7.
[20]WANG PH,WANG HC.Risk factors to predict drug-resistant pathogens in hemodialysis-associated pneumonia[J].BMC Infect Dis,2016,16(1):377.
[21]黄承龙,于锋,葛卫红,等.慢性阻塞性肺疾病急性加重期的病原菌分布与抗菌药物的应用分析[J].安徽医药,2015,19(6):1199-1201.