老年性社区获得性肺炎病原菌及药敏结果分析

发布时间：2018-03-22 10:18

本文选题：老年人　切入点：社区获得性肺炎　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的分析老年性社区获得性肺炎的病原菌分布及药物敏感性情况,为临床合理使用抗菌药物提供数据支持。方法对2012年～2014年我院收治的165例老年性社区获得性肺炎患者的痰培养结果进行统计分析。结果共培养分离出病原菌112株,其中包括82株革兰氏阴性菌(占73.2%),26株革兰氏阳性菌(占23.2%),4株真菌(占3.6%),所占比例位居前五位的是肺炎克雷伯菌28株(25%)、大肠埃希菌17株(15.1%)、铜绿假单胞菌12株(10.7%)、肺炎链球菌11株(9.8%)、流感嗜血杆菌10株(8.9%)；药敏试验结果显示：肺炎克雷伯菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦敏感率达到100%,对左氧氟沙星、头孢他啶、头孢吡肟、环丙沙星、氨曲南、阿米卡星均保持较高的敏感性(超过80%),而对氨苄西林、头孢呋辛耐药率超过70%,头孢哌酮、哌拉西林联合β-内酰胺酶抑制剂的复方制剂较单用头孢哌酮、哌拉西林敏感性有显著提高。大肠埃希菌对亚胺培南全部敏感,对阿米卡星、哌拉西林/他唑巴坦敏感性较高(超过80%),对氨苄西林、头孢噻肟、头孢呋辛、头孢吡肟、左氧氟沙星、头孢他啶、庆大霉素、环丙沙星、复方新诺明、氨曲南的耐药率超过了50%。铜绿假单胞菌对左氧氟沙星、亚胺培南、环丙沙星、阿米卡星的敏感率达到100%,对头孢他啶、头孢哌酮/舒巴坦、头孢吡肟、庆大霉素、哌拉西林/他唑巴坦等药物有着较高敏感性(超过80%),对米诺环素以及复方新诺明敏感性偏低。肺炎链球菌对万古霉素全部敏感,对阿莫西林/克拉维酸钾、克林霉素敏感性较好(超过80%),对大环内酯类敏感性在63%左右,而对青霉素、头孢呋辛耐药率高。金黄色葡萄球菌对万古霉素全部敏感,对阿米卡星、替考拉宁、左氧氟沙星敏感性较高(超过80%),而对克林霉素、阿奇霉素、红霉素、苯唑西林等耐药率较高,对青霉素全部耐药。结论老年性社区获得性肺炎以革兰氏阴性杆菌感染为主,在经验性选择抗生素时当首选含p-内酰胺酶抑制剂的复方制剂较为恰当。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and drug sensitivity of senile community-acquired pneumonia. Methods the sputum culture results of 165 patients with senile community-acquired pneumonia from 2012 to 2014 were statistically analyzed. Among them were 82 Gram-negative bacteria (73.2mb) and 26 Gram-positive bacteria (23.22U, 4 fungi), 28 Klebsiella pneumoniae (28 strains), 17 Escherichia coli (15.1b), 12 Pseudomonas aeruginosa (10.7B), and pneumonia (10.7B), among them, 28 strains of Klebsiella pneumoniae were in the top five, 17 strains of Escherichia coli and 15. 1% of Escherichia coli, 12 strains of Pseudomonas aeruginosa, and 10. 7% of pneumonia. 11 strains of Streptococcus and 10 strains of Haemophilus influenzae showed that Klebsiella pneumoniae was resistant to imipenem, The sensitivity of cefoperazone / sulbactam, piperacillin / tazobactam to levofloxacin, ceftazidime, cefepime, ciprofloxacin, aztreonam and amikacin were 100%. Cefoperazone, piperacillin and 尾 -lactamase inhibitor have significantly higher sensitivity to cefuroxime than cefoperazone and piperacillin alone. Escherichia coli is all sensitive to imipenem and is sensitive to amikacin. Piperacillin / tazobactam is highly sensitive (more than 80%) to ampicillin, cefotaxime, cefuroxime, cefepime, levofloxacin, ceftazidime, gentamicin, ciprofloxacin, compound sulfamide, The sensitivity of Pseudomonas aeruginosa to levofloxacin, imipenem, ciprofloxacin and amikacin was 100, ceftazidime, cefoperazone / sulbactam, cefepime, gentamicin, Piperacillin / tazobactam and other drugs have high sensitivity (more than 80 kum, low sensitivity to minocycline and compound sulfamine. Streptococcus pneumoniae is all sensitive to vancomycin, amoxicillin / potassium clavulanate, etc.). Clindamycin is more sensitive (more than 80%, sensitivity to macrolides is about 63%, but to penicillin, cefuroxime is high. Staphylococcus aureus is all sensitive to vancomycin, to amikacin, teicoplanin. The sensitivity of levofloxacin was higher (more than 80%), while the resistance rates to clindamycin, azithromycin, erythromycin and oxacillin were higher, and all of them were resistant to penicillin. Conclusion Gram-negative bacilli infection is the main cause of senile community-acquired pneumonia. When selecting antibiotics empirically, it is more appropriate to choose compound preparation containing p- lactamases inhibitor.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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