摘要
目的探讨老年患者肺炎克雷伯杆菌的感染现状及病原菌分布与耐药情况,为预防和控制老年患者该菌的感染提供诊断及用药依据。方法回顾性调查2012年1月至2015年1月我院≥65岁(WHO关于老年人定义)感染肺炎克雷伯杆菌的老年患者576例,采用CLSI 2014年版判断标准和Kirby-Bauer纸片扩散法对试验结果进行判定,并采用SPSS 19.0统计软件进行统计学分析。结果 576例肺炎克雷伯菌院内感染的高危因素有:住院时间长、高龄、基础疾病复杂、广谱抗菌药物的使用、进行过创伤性操作等。该菌主要来源于痰液、尿液和血液,分别占39.76%、18.75%、16.84%;主要分布于ICU、呼吸内科病房、神经外科病房、介入病房,且明显多于其他病房。药敏结果显示,肺炎克雷伯菌对碳青霉烯类敏感性最高,其敏感性明显高于不加酶抑制剂的抗菌药物;对第3代头孢菌素头孢替坦比较敏感,耐药率仅为3.58%,而对头孢曲松、头孢噻肟及第1、2代头孢菌素耐药率均较高;氨基糖苷类中的阿米卡星敏感率较高,为94.44%;喹诺酮类的耐药率在30%左右;另外,氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢唑喃钠、呋喃妥因、哌拉西林耐药率则均大于70%。结论老年患者易罹患院内感染,感染致病菌呈现多重耐药,且检出株数呈逐年上升趋势。对临床经验治疗来说,青霉素类、喹诺酮类及第一、二代头孢菌素类药物耐药率较高,已不适用于该菌所致感染的治疗,阿米卡星敏感率较高,可作为仅次于碳青霉烯类用于控制该菌感染的第二选择,同时应加强药敏监测及抗菌药物临床使用管理,以指导临床用药、预防和减少多重耐药菌株的产生。
Objective To investigate the drug resistance of klebsiella pneumonia among elderly patients,as to provide theoretical basis for clinical prevention and treatment.Methods The data of 576 elderly patients[（age ≥65years） the definition is applied from WHO]with klebsiella pneumonia infection were analyzed from January 2013 to January 2015 in our hospital.Kirby-Bauer disc diffusion method and the judgment standard（CLSI edition,2014） was used to monitor the drug resistance,and SPSS 19.0 statistical software was used for data analysis.Results High risk factors of 576 elderly patients with klebsiella pneumonia infection：long time hospitalization,advanced age,severe basic diseases,the use of broad-spectrum antibiotics,having traumatic operation.Klebsiella pneumonia mainly was detected from sputum,urine and blood,the resistance rate respectively were 39.76%,18.75%and 16.84%.Mainly in the intensive care unit（ICU）,respiratory medicine,neurosurgery medicine,interventional ward,and significantly more than other wards.Drug sensitive test showed that penicillium carbon alkene sensitivity was the highest,the sensitive rates of these drugs with enzyme inhibitors was obviously higher than these without.The cefotetan of the third-generation cephalosporins showed more sensitive resistance,the resistance rate was 3.58%,while the drug resistance rates of ceftriaxone,cefotaxime and the 1,2-generation cephalosporins showed higher resistance,the sensitive rate of the amikacin of aminoglycosides was 94.44%.The drug resistance rates of Quinolones were about 30%;Other drugs with resistant rate more than 70%,included ampicilin,ampicilin/sulbacam,cefazolin,cefuzonam sodium,macrodantin,piperaciliin.Conclusion For the complicated basic diseases,sensitive physique of elderly patients,drug resistance of pathogenic bacteria tended to be multiple drug resistance,and detection rate showed a trend of rising year by year.For clinical empirical treatment,the resistance rates of the penicillin class,quinolones and first and second generation cephalosporin were higher,which was not used to the infection of Klebsiella pneumoniae;the sensitive rates of the amikacin of aminoglycoside were higher,which can be used as second choice to control the bacteria infection.Drug sensitivity and drug resistance monitoring should be strengthened,so as to guide the clinical medication,at the same time,strengthen the management of the clinical use of antibacterial drugs,to prevent and reduce the generation of multiple drug-resistant strains
出处
《实用药物与临床》
CAS
2016年第1期92-95,共4页
Practical Pharmacy and Clinical Remedies
关键词
肺炎克雷伯杆菌
药敏性
感染
临床特征
老年患者
Klebsiella pneumonia
Drug sensitivity
Infection
Clinical characteristics
Elderly patient
