老年护理医院患者呼吸道感染细菌分布及耐药性分析
摘要
目的:了解老年护理医院院内感染细菌分布及耐药性,为呼吸道感染患者合理使用抗生素提供依据。方法:对402例痰培养阳性标本进行病原菌种类构成及主要病原菌对抗生素耐药情况分析。结果:402例阳性痰标本分离出467株细菌,以革兰阴性杆菌为主(84.37%),居前5位的是铜绿假单胞菌(28.05%),奇异变形杆菌(23.13%),肺炎克雷伯菌(10.06%),大肠埃希菌(7.28%)和鲍曼不动杆菌(4.71%)。革兰阳性球菌占15.63%,居前3位的是金黄色葡萄球菌(9.21%),无乳链球菌(2.78%)和溶血葡萄球菌(1.71%)。铜绿假单胞菌对左氧氟沙星耐药率59.5%;奇异变形杆菌对氨苄西林耐药率97.2%,对喹诺酮类耐药率在90%以上,对头孢呋辛及头孢曲松耐药率分别为57.4%及53.7%;肺炎克雷伯菌对氨苄西林耐药率85.1%,对头孢呋辛及头孢曲松耐药率分别为48.9%及42.6%;大肠杆菌对氨苄西林及哌拉西林的耐药率高达97.1%,对头孢菌素类广泛耐药,几乎均在70%以上,对左氧氟沙星耐药率为85.3%;鲍曼不动杆菌对哌拉西林耐药率为72.7%,对头孢菌素类广泛耐药,几乎均在70%以上,对左氧氟沙星耐药率为63.6%,对美洛培南耐药率63.6%。金黄色葡萄球菌对青霉素G耐药率100%,对左氧氟沙星耐药率72.1%;无乳链球菌对红霉素耐药率46.2%;溶血葡萄球菌对青霉素G、红霉素耐药率100%,对左氧氟沙星耐药率87.5%;但这三种细菌对万古霉素均无耐药。结论:老年护理医院呼吸道感染主要为医院内感染,以革兰阴性杆菌为主且分布广泛,主要病原菌对青霉素类、头孢类、喹诺酮类抗生素耐药性明显,对氨基糖苷类、含酶抑制剂抗生素及碳青霉烯类耐药性较低,为临床合理用药提供有益的依据。
引文
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[4]贾巧,杜万红.老年病科院内肺部感染细菌分布及耐药性分析[J].湖南师范大学学报:医学版,2013,10(2):26-28.
[5]花宝贺,王晓燕,王新利,等.老年患者下呼吸道感染细菌分布及耐药性监测[J].中华医院感染学杂志,2007,17(7):891-894.
[6]高媛,徐雅萍,李晓霞,等.老年患者铜绿假单胞菌感染调查及耐药性分析[J].中华医院感染学杂志,2010,20(11):1607-1609.
[7]García-Prado E,Cordero E,Alamo JM,et al.Descriptive study of infectious complications in 109 Consecutive liver ransplant recipients[J].Enferm Infec Microbiol Clin,2009,27(4):199-205.
[8]畅晋,孟雪,陈晓炜,等.2013年某综合医院医院感染病原菌及耐药情况分析[J].医学研究与教育,2016,33(1):35-41.
[9]朱芳,罗艳香,程含,等.常见医院感染病原菌的构成比及耐药性分析[J].重庆医学,2013,42(36):4450-4452.
[10]Maragakis LL,Perl TM.Acinetobacter baumannii:epidemiology,antimicrobial resistance,and treatment opitions[J].Clin Infect Dis,2008,46(8):1254-1263.
[11]Tsakris A,Ikonomidis A,Pournras S,et al.VIM-1 metallo-beta-lactamase in acinetobacter baumannii[J].Emerg Infect Dis,2006,12(6):981-983.
[12]Skvarc M,Stubljar D,Rogina P,et al.Non-culture-based methods to diagnose bloodstream infection:does it work[J]?Eur JMicrobiol Immunol(Bp),2013,3(2):97-104.
[13]Sun W,Chen H,Liu Y,et al.Prevalence and characterization of helerogeneous Vancomycin-Intermediate staphylococcus aureus isolates from 14 cities in China[J].Antimicrob Agents Chemother,2009,53(9):3642-3649.
[14]Harbarth S.Epidemiologic methods for the prevention of nosocomial infections[J].Int J Hyg Environ Health,2000,203(2):153-157.
[15]Marwick CA,Yu N,Lockhart MC,et al.Community-associated Clostridium difficile infection among older People in Tayside,Scotland,is associated with antibiotic exposure and care home residence:cohort study with nested case-control[J].J Antimicrob Chemother,2013,68(12):2927-2933.
[16]Dalgleish L,Jhattu H,Gomersall JS.Daily 2%chlorhexidine gluconate Bath Wash in a tertiary adult intensive care and high dependency units to reduce iosk of hospital acquired multi resistant organisms:a best practice implementation project[J].JBIDatabase System Rev Implement Rep,2015,13(6):434-448.