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目的对老年重症肺炎患者感染主要病原菌种类、耐药情况以及死亡危险因素进行分析,为临床医师预防感染及药物治疗提供参考。方法选取2013年4月-2015年3月期间在湖北中山医院就诊的272例老年重症肺炎患者,进行痰液标本的采集。采用API系统分离和鉴定菌株,明确病原菌菌谱;药敏试验的监测则采用K-B法,并观察病原菌耐药情况。运用SPSS19.0统计学软件进行数据分析。结果 272例痰液标本中检出病原菌242株(88.97%),其中,革兰阴性菌160株(66.12%),检出率最高,以鲍曼不动杆菌(53株,21.90%)和铜绿假单胞菌(37株,15.29%)较为常见。鲍曼不动杆菌对氨苄西林和头孢唑林耐药率较高,分别为100.00%和88.68%,而对亚胺培南、环丙沙星和阿米卡星耐药率则较低,均<25.00%;铜绿假单胞菌对头孢唑林、氨苄西林和头孢呋辛耐药率较高,分别为94.59%、78.38%和78.38%,而对环丙沙星和阿米卡星较为敏感,耐药率均为16.22%。年龄≥70岁(P=0.03)、累计受损器官≥3个(P=0.01)是老年重症肺炎患者死亡的危险因素。结论革兰阴性菌是老年重症肺炎患者感染的主要致病菌,且各菌株耐药性普遍较高,提示临床实践中应合理选择抗菌药物,对年龄≥70岁且伴随多器官功能受损的患者应引起高度重视并积极进行综合治疗,对降低重症肺炎病死率具有重要临床意义。
Objective To analyze the main pathogen types, drug resistance and risk factors of death in elderly patients with severe pneumonia and provide references for clinicians to prevent infection and drug treatment. Methods A total of 272 elderly patients with severe pneumonia who were treated in Zhongshan Hospital of Hubei Province from April 2013 to March 2015 were selected for sputum sample collection. Isolation and identification of strains using API system, clear pathogenic bacteria spectrum; drug susceptibility testing using the K-B method and observe the pathogen resistance. Using SPSS19.0 statistical software for data analysis. Results A total of 242 pathogenic bacteria (88.97%) were detected in 272 sputum samples, of which 160 (66.12%) were Gram-negative bacteria with the highest detection rate. Acinetobacter baumannii (53 strains, 21.90% Pseudomonas (37 strains, 15.29%) is more common. Acinetobacter baumannii had high resistance rate to ampicillin and cefazolin, which were 100.00% and 88.68%, respectively, whereas the resistance rates to imipenem, ciprofloxacin and amikacin were lower <25.00%. Pseudomonas aeruginosa had a higher resistance rates to cefazolin, ampicillin and cefuroxime, 94.59%, 78.38% and 78.38% respectively, but sensitive to ciprofloxacin and amikacin , Resistance rate was 16.22%. Age ≥70 years old (P = 0.03), cumulative damage organs≥3 (P = 0.01) were the risk factors of death in elderly patients with severe pneumonia. Conclusions Gram-negative bacteria are the main pathogens of infection in elderly patients with severe pneumonia, and the drug resistance of each strain is generally high, suggesting that the clinical practice should be an appropriate choice of antimicrobial agents, age ≥ 70 years old with multiple organ dysfunction Patients should attach great importance to and actively carry out comprehensive treatment, to reduce the mortality of severe pneumonia has important clinical significance.