摘要
目的了解中老年2型糖尿病(T2DM)合并败血症患者病原菌分布及其对抗生素的敏感性。方法回顾性分析我科2004年10月至2009年7月51例中老年T2DM合并败血症患者的临床资料。结果大肠埃希菌31株(ES-BL阳性4株),肺炎克雷伯菌11株(ESBL2株),鲍曼醋酸不动杆菌1株,葡萄球菌10株(MRS 1株),其他阳性球菌4株;药敏试验中对革兰阴性杆菌敏感多为三代头孢加酶抑制剂、三代以上喹诺酮类、氨基糖苷类、碳氢酶烯类抗生素;对革兰阳性球菌敏感多为万古霉素、庆大霉素、呋喃妥因。结论 T2DM合并败血症病原菌多为革兰阴性杆菌,尤其大肠埃希菌。建议首选半合成青霉素加酶抑制剂、头孢菌素加酶抑制剂、三代以上喹诺酮类。氨基糖苷类抗生素多敏感,但中老年患者多合并肾脏病变,需慎用。治疗中应合理使用抗生素,警惕二重感染,加强免疫及营养支持,加强病原菌检测及耐药性监测。
Objective To analyze sepsis distribution and antibiotic sensitivity in elderly type 2 diabetes.Methods A retrospective analysis was made for 51 cases of sepsis diagnosed by blood cultures and clinical data.Results 31 cases were Escherichia coli(4 cases were positive ESBL),11 cases were Klebsiella pneumoniae(2 cases were positive ESBL),1 case was Acetic acid acinetobacter baumannii,10 cases were Staphylococci(1 case was MRS),4 cases were other Gram-positive cocci.The major responsive antibiotics to Gram-negative bacilli were tert-cephalosporin especial with enzyme inhibitor,the above tert-quinolones,aminoglycosides antibiotics and enzyme vinyl hydrocarbon antibiotics in susceptibility test.The major responsive antibiotics to Gram-positive cocci were vancomycin,gentamicin and furadantin.Conclusion Gram-negative bacilli were the major ones,especial Escherichia coli.suggest the first selected antibioticses were semisynthetic penicillin with enzyme inhibitor、cephalosporin with enzyme inhibitor、the above tert-quinolones or Enzyme vinyl hydrocarbon antibiotics.Aminoglycoside antibiotics,however,was used prudently even though they were still sensitive,because in elderly patients,many with renal disease,Antibiotics were be used rationally,dual infections should be vigilanced.We should strengthen immunizing and nutritional support,and strengthen the detection for pathogenic bacteria and the monitoring for drug resistance.
出处
《实用医院临床杂志》
2010年第4期37-39,共3页
Practical Journal of Clinical Medicine
关键词
糖尿病
败血症
病原菌
抗生素
中老年
药效
Diabete
Septicaemia
Pathogens
Antibiotics
Elderly
Efficaly
