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目的:了解县级医院老年患者医院获得性肺炎的病原菌种类分布及耐药特征,为临床科室预防与治疗老年患者医院获得性肺炎选择抗生素提供参考指南。方法:对255例年龄≥60岁的获得性肺炎患者原始病历进行逐份查阅统计;痰液或下呼吸道吸取物的无菌采集、细菌培养、种型鉴定按照临床微生物检验的技术路线进行实验操作;药敏检测采用WHO规定的KB法,抑菌圈测量,敏感、中介、耐药数据比照CLSI最新规则评价;数据统计学采用WHONET 5.6软件处理,实验条件遵照室内质量控制条例进行标准化管理。结果:279株病原菌中,位于前6位的细菌是:肺炎克雷伯菌(24.7%)、铜绿假单胞菌(15.4%)、金黄色葡萄球菌(14.7%)、鲍曼不动杆菌(13.3%)、白色假丝酵母菌(7.5%)、大肠埃希菌(5.7%)。药物检测发现:大部分病原菌对临床抗菌药物产生了严重的抗药性:MRSA检出率为46.3%,产ESBLs大肠埃希菌和肺炎克雷伯菌检出率为47.1%,耐亚胺培南铜绿假单胞菌和鲍曼不动杆菌分别达到25.6%、32.4%;革兰阴性杆菌耐药率<20%的抗菌药物有阿米卡星、头孢哌酮/舒巴坦,耐药率最高的是磺胺甲噁唑/甲氧苄啶,均>65%;但肠杆菌科菌株对碳青霉烯类药物100%敏感;金黄色葡萄球菌对糖肽类药物100%敏感。结论:老年患者医院获得性肺炎的病原菌耐药性上升趋势明显,务必采取有效的治理措施,严格医师抗生素处方管理,致力于改变细菌耐药性快速上升的不良现象。
Objective: To understand the distribution and drug resistance of pathogenic bacteria in hospital-acquired pneumonia in elderly patients in county-level hospitals and to provide a reference guide for the prevention and treatment of hospital-acquired pneumonia in elderly patients by selecting antibiotics. Methods: A total of 255 cases of patients with acquired pneumonia aged 60 or older were enrolled in the original medical records. The sputum or lower respiratory tract aspirate samples were collected aseptically, cultured and identified according to the technical route of clinical microbiological tests ; Drug susceptibility testing using the KB method prescribed by the WHO, inhibition zone measurement, sensitive, intermediary, drug resistance data according to the latest CLSI evaluation; data statistics using WHONET 5.6 software processing, laboratory conditions in accordance with indoor quality control regulations for standardized management. Results: Of the 279 pathogenic bacteria, the top 6 bacteria were: Klebsiella pneumoniae (24.7%), Pseudomonas aeruginosa (15.4%), Staphylococcus aureus (14.7%), Acinetobacter baumannii 13.3%), Candida albicans (7.5%), Escherichia coli (5.7%). Drug tests found that most of the pathogenic bacteria had serious resistance to clinical antimicrobial agents: the detection rate of MRSA was 46.3%, the detection rate of ESBLs-producing Escherichia coli and Klebsiella pneumoniae was 47.1%, resistance to imipenem Pseudomonas aeruginosa and Acinetobacter baumannii respectively reached 25.6% and 32.4%. Amikacin and cefoperazone / sulbactam were the most common antimicrobial agents with antibiotic resistance rate of <20% Were sulfamethoxazole / trimethoprim, both> 65%; but Enterobacteriaceae strains were 100% sensitive to carbapenems; Staphylococcus aureus was 100% sensitive to glycopeptides. Conclusion: The pathogen resistance of hospital-acquired pneumonia in elderly patients shows an obvious upward trend. Therefore, it is imperative to take effective measures to control the prescribing of antibiotics and to change the adverse effect of rapidly increasing bacterial resistance.