老年重症肺炎患者病原菌构成及其死亡危险因素

发布时间：2018-01-11 09:36

本文关键词：老年重症肺炎患者病原菌构成及其死亡危险因素　出处：《中国老年学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨老年重症肺炎患者病原菌构成及其死亡危险因素。方法选取老年重症肺炎住院患者136例,详细记录患者性别、年龄、合并基础疾病种类、实验室检查结果,全面评估患者肺部感染情况,对患者进行痰液检查,行相关病原学检查。结果 136例患者痰液标本中共检出病原菌114株。其中革兰阴性菌75株,以鲍曼不动杆菌、铜绿假单胞菌最常见;革兰阳性菌26株,以耐甲氧西林金黄色葡萄球菌、溶血性葡萄球菌、肺炎链球菌较为常见;真菌13株,以白色假丝酵母菌为主。革兰阴性菌中鲍曼不动杆菌对氨苄西林不敏感,耐药率100.00%,对亚胺培南西司他汀钠、阿米卡星较敏感,耐药率分别为3.85%和15.38%;铜绿假单胞菌对阿米卡星敏感,耐药率为16.67%,对氨苄西林耐药率较高,为77.78%。革兰阳性菌中耐甲氧西林葡萄球菌对利奈唑胺钠敏感性较高,耐药率为23.07%,对氨苄西林、亚胺培南西司他汀钠不敏感,耐药率高达100.00%;溶血性葡萄球菌对亚胺培南西司他汀钠和利奈唑胺、头孢吡肟较为敏感,耐药率为14.29%和28.57%,28.57%,而对头孢呋辛和氨苄西林不敏感,耐药率均为71.43%和85.71%。累及器官超过3个、合并慢性阻塞性肺疾病(COPD)是老年重症肺炎患者死亡的独立危险因素。结论老年重症肺炎患者主要致病菌为革兰阴性菌,主要革兰阴性菌对阿米卡星,亚胺培南西司他汀钠敏感,主要革兰阳性菌对利奈唑胺敏感,而患者的愈后与累及器官超过3个、合并COPD呈正相关。
[Abstract]:Objective to investigate the pathogenic bacteria composition and death risk factors in elderly patients with severe pneumonia. Methods 136 elderly patients with severe pneumonia were selected to record their sex, age and basic diseases in detail. The results of laboratory examination were used to evaluate the pulmonary infection and sputum examination. Results 114 strains of pathogenic bacteria were detected in sputum of 136 patients, 75 of them were Gram-negative bacteria, Acinetobacter baumannii and Pseudomonas aeruginosa were the most common. Gram-positive bacteria 26 strains, methicillin-resistant Staphylococcus aureus, haemolytic Staphylococcus, Streptococcus pneumoniae more common; Acinetobacter baumannii was not sensitive to ampicillin in Gram-negative bacteria, and the drug resistance rate was 100.00m, and was sensitive to imipenem and amikacin. The drug resistance rates were 3.85% and 15.38, respectively. Pseudomonas aeruginosa was sensitive to amikacin with a resistance rate of 16.67 and a higher resistance to ampicillin. The sensitivity of methicillin-resistant Staphylococcus to linazolamine sodium was higher, the resistance rate was 23.07, and was not sensitive to ampicillin and imipenem sodium. The drug resistance rate was as high as 100.00g. Staphylococcus haemolyticus was sensitive to imipenem statin sodium and linazolamine and cefepime with resistance rates of 14.29% and 28.57% respectively. Cefuroxime and ampicillin were insensitive to cefuroxime and ampicillin. The drug resistance rates were 71.43% and 85.71, respectively. More than 3 organs were involved. Conclusion the main pathogenic bacteria in elderly patients with severe pneumonia are gram-negative bacteria and the main gram-negative bacteria to amikacin. Imipenem cilastatin sodium was sensitive and the main gram-positive bacteria were sensitive to linazolamine, and the recovery of the patients was positively correlated with the involvement of more than 3 organs and COPD.
【作者单位】：武汉市红十字会医院武汉市第十一医院重症医学科;
【分类号】：R563.1;R446.5
【正文快照】： 肺部感染是全球第三大死亡原因〔1〕,其中50%的老年患者因为各种病原菌引起的肺部感染死亡,肺部感染的发病率和死亡率与患者年龄呈正比〔2〕。老年重症肺炎(SP)患者,除患有肺炎外,还伴有呼吸系统衰竭和(或)其他系统受累;胸部影像学显示肺叶大部分受累〔3〕,或发病危重,入院48

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