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目的分析长期住院老年患者下呼吸道感染的病原菌分布以及耐药特点,为临床诊断及合理用药提供依据。方法回顾性分析2014年7月-2015年6月期间湘雅医院长期住院老年患者的910份下呼吸道标本的细菌培养及药敏结果。结果 910份标本中共分离出病原菌1 315株,其中革兰阴性杆菌1 073株(81.60%),以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌为主。革兰阳性球菌61株(4.64%),以金黄色葡萄球菌为主。真菌177株(13.46%),以白色念珠菌为主。其它4株(0.30%)。其中396(43.52%)份标本为两种以上病原菌混合感染。铜绿假单胞菌对多数抗菌药物的耐药率均在30.00%以上,对美罗培南的耐药率为38.70%。鲍曼不动杆菌对各种抗菌药物的耐药率均较高,对美罗培南的耐药率达到76.50%。肺炎克雷伯菌对美罗培南的耐药率为19.42%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌占60.00%,万古霉素、利奈唑胺和替考拉宁对金黄色葡萄球菌有较好的抗菌活性,未发现耐药株。结论长期住院老年患者下呼吸道感染的病原菌以革兰阴性杆菌为主,细菌耐药情况严重,应根据药敏试验合理选择抗菌药物。
Objective To analyze the distribution of pathogens and the drug resistance characteristics of lower respiratory tract infection in elderly patients with long-term hospitalization and provide the basis for clinical diagnosis and rational drug use. Methods The bacterial culture and drug susceptibility test results of 910 lower respiratory tract specimens of long-term hospitalized elderly patients in Xiangya Hospital from July 2014 to June 2015 were retrospectively analyzed. Results A total of 1 315 strains of pathogens were isolated from 910 samples, of which 1 073 (81.60%) were Gram-negative bacilli. The main pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii and Escherichia coli . Gram-positive cocci 61 strains (4.64%), Staphylococcus aureus-based. 177 fungi (13.46%), mainly Candida albicans. The other 4 strains (0.30%). Among them, 396 (43.52%) specimens were mixed with two or more pathogens. The resistance rate of Pseudomonas aeruginosa to most antibacterials was over 30.00%, and the resistance rate to Meropenem was 38.70%. Acinetobacter baumannii had a higher rate of resistance to various antimicrobial agents, and the rate of resistance to meropenem reached 76.50%. Klebsiella pneumoniae meropenem resistance rate was 19.42%. Staphylococcus aureus methicillin-resistant Staphylococcus aureus accounted for 60.00%, vancomycin, linezolid and teicoplanin Staphylococcus aureus has good antibacterial activity, no drug-resistant strains were found. Conclusions Gram-negative bacilli are the main pathogenic bacteria of lower respiratory tract infection in elderly patients with long-term hospitalization. Bacterial drug resistance is serious. Antibacterial drugs should be selected reasonably according to drug sensitivity test.