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目的探讨长期住院老年患者发生医院获得性肺炎的致病菌特点,以采取有效的预防控制措施。方法回顾性分析2008年7月—2012年12月长期住院的老年患者发生医院获得性肺炎316例的病原菌分布及耐药性。结果 316例老年患者中共检出病原菌467株,其中革兰阴性菌占66.81%,革兰阳性菌占15.20%,真菌占17.99%。病原菌株以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌(MRSA)和白色念珠菌为主。在革兰阴性菌中,ESBLs检出率为39.42%,主要为大肠埃希菌(52.00%)和肺炎克雷伯菌(43.07%),其对亚胺培南、头孢呱酮钠/舒巴坦、呱啦西林/他唑巴坦耐药率尚较低;鲍曼不动杆菌仅头孢哌酮钠/舒巴坦耐药率相对较低;铜绿假单胞菌对氨苄西林耐药率达到100.00%,但对亚胺培南、阿米卡星等多种抗菌药仍敏感。在革兰阳性菌中,MRSA检出率为47.22%,未发现耐万古霉素的葡萄球菌;此外,抗真菌药物仍多为敏感。结论长期住院的老年患者医院获得性肺炎的发生率高,病原菌耐药率高,易混合感染,应尽量缩短住院时间。
Objective To investigate the characteristics of hospital-acquired pneumonia pathogens in long-term hospitalized elderly patients in order to take effective preventive and control measures. Methods The pathogen distribution and drug resistance of 316 patients with hospital-acquired pneumonia who had been hospitalized for long-term in July 2008-December 2012 were retrospectively analyzed. Results A total of 467 pathogenic bacteria were detected in 316 elderly patients, of which Gram-negative bacteria accounted for 66.81%, Gram-positive bacteria accounted for 15.20% and fungi accounted for 17.99%. Pathogenic strains of Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus (MRSA) and Candida albicans based. In Gram-negative bacteria, the detection rate of ESBLs was 39.42%, mainly Escherichia coli (52.00%) and Klebsiella pneumoniae (43.07%). The detection rate of imipenem, cefotaxime sodium / The rate of resistance to cefoperazone sodium / sulbactam was relatively low in Acinetobacter baumannii; the rate of resistance to ampicillin in Pseudomonas aeruginosa reached 100.00% However, imipenem, amikacin and other antimicrobials are still sensitive. Among Gram-positive bacteria, the detection rate of MRSA was 47.22%. No vancomycin-resistant staphylococci were found. In addition, anti-fungal drugs were still mostly sensitive. Conclusions The incidence of hospital acquired pneumonia in elderly patients who have been hospitalized for a long period of time is high, and the drug resistance rate of pathogens is high, which is easy to be mixed and infected. The hospitalization time should be shortened as much as possible.