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目的研究老年糖尿病患者败血症的临床和病原菌特点。方法对2004年1月~2008年12月住院的87例老年糖尿病合并败血症患者的临床资料进行回顾性分析。结果共分离出108株病原菌;其中革兰阴性菌58株(53.7%),革兰阳性菌35株(32.4%),真菌15株(13.9%)。致病菌入侵途径分别为呼吸道、泌尿系、胃肠道、胆系、破损皮肤、深静脉导管。常见的病原菌为大肠埃希菌(21.3%)、凝固酶阴性葡萄球菌(18.5%)、肺炎克雷伯菌(12.0%)、白色念珠菌(7.4%)、鲍氏不动杆菌(5.6%)。大肠埃希菌、肺炎克雷伯菌ESBLs检出率分别为47.8%和23.1%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率为100%。耐甲氧西林葡萄球菌(MRSA)和MRCNS表现为高度的耐药性,但未发现对万古霉素和替考拉宁耐药菌株。结论老年糖尿病合并败血症常见,肠杆菌科细菌、葡萄球菌属和真菌是主要病原菌。尽早行血培养,开展病原菌耐药性监测,对指导临床合理使用抗菌药物和控制感染十分重要。
Objective To study the clinical and pathogenic characteristics of sepsis in elderly diabetic patients. Methods The clinical data of 87 elderly diabetic patients with sepsis admitted from January 2004 to December 2008 were analyzed retrospectively. Results 108 pathogens were isolated, of which 58 (53.7%) were Gram-negative, 35 (32.4%) were Gram-positive and 15 (13.9%) were fungi. Pathogenicity of pathogens were respiratory, urinary tract, gastrointestinal tract, gallbladder, damaged skin, deep vein catheter. Common pathogens were Escherichia coli (21.3%), coagulase negative Staphylococcus (18.5%), Klebsiella pneumoniae (12.0%), Candida albicans (7.4%), Acinetobacter baumannii . The detection rates of ESBLs of Escherichia coli and Klebsiella pneumoniae were 47.8% and 23.1%, respectively. The detection rate of methicillin-resistant coagulase-negative staphylococci (MRCNS) was 100%. Methicillin-resistant Staphylococcus aureus (MRSA) and MRCNS showed high resistance but no vancomycin and teicoplanin-resistant strains were found. Conclusion In elderly patients with diabetes mellitus and sepsis, enterobacteriaceae, staphylococcus and fungi are the main pathogenic bacteria. Blood culture as soon as possible to carry out the monitoring of pathogenic bacteria drug resistance, the clinical rational use of antimicrobial agents and infection control is very important.