老年下呼吸道院内感染细菌耐药性分析

目的通过对老年下呼吸道院内感染细菌耐药性的分析，为临床合理使用抗生素提供依据。方法对下呼吸道院内感染的患者中分离出来的细菌，以珠海黑马生物工程有限公司做微生物分析系统BACT-TST稀释法做药敏试验。以美国临床实验室标准委员会（NCCLS）2002年推荐的表型确认试验检测超广谱β-内酰胺酶（ESBLs）。结果老年医院获得性肺炎（Hospital acquired pneumoniae HAP）和社区获得性肺炎（Community acquired pneumoniae CAP）细菌对16种抗生素的耐药率分别为：青霉素95．2％和90、8％，哌拉西林80％和76％，头孢噻肟钠39．5％和35．6％，西力欣46．2％和42．3％，头孢哌酮40％和30％．阿米卡星48．6％和42．8％，环丙沙星56％和51．6％，左氧氟沙星50％和41．7％，头孢哌酮／舒巴坦3．5％和1．23％．阿莫西林／克拉维酸钾10．5％和6．7％，哌拉西林／他唑巴坦2．2％和1．03％，氨苄西林／舒巴坦3．8％和2．36％，头孢他定16．7％和11．7％，头孢曲松14．6％和10.2％，亚胺培南0，万古霉素0。其中亚胺培南，万古霉素，头孢哌酮／舒巴坦。哌拉西林／他唑巴坦对产生ESBLs耐药率最低，分别是0、0、0、5.8％。结论老年下呼吸道院内感染细菌耐药性和ESBLs检出率均显著高于院外感染者，亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、万古霉素是治疗产ESBLs菌株感染引起的有效抗生素。

Analysis of antibiotic resistance of bacteria in old patients with lower respiratory tract infections hospital acquired pneumonia

OBJECTIVE To investigate antibiotic resistance of bacteria in old patients with lower respiratory tract infections.METHODS Dilution methods was used to evaluate the drug sensitivity in bacteria from patients with lower respiratory tract infection. HAP phenotypic confirmatory test recommended by NCCLS1999 was used to detect extended-spectrum beta-lactamases(ESBLS). RESULTS Bacteria to 16 antibiotics in old patients with HAP and CAP were penliciline 95.2% VS 90.8%,piperacillin 80% VS 76%,cefotaxime 39.5% VS 35.6%,cefuroxime 46.2% VS 42.3%,cefoperazone 40% VS 30%,amikacin 48.6% VS 42.8%.ciprofloxacin 56% VS 51.65%,levoglox-acin 50% VS 41.7%.cefoperazone/sulbactam 3.5% VS 1.23%,amoxicillin/clavulanatek 10.5% VS (6.7%),piperacillin/tazobactam 2.3% VS 1.03%,ampicillin/sulbactam 3.8% VS 2.36%,ceftazidime16.7% VS 11.7%,ceftriaxone (14.6%) VS 10.2%,imipenem 0 VS 0,vancomycin 0 vs 0. The resistant rate of ESBLs-producing strains to imipinem,cefoperazone/sulbactam,piperacillin/tazobactam and vancomycin was the lowest,being 0, 0,0 and 5.8%.CONCLUSION The resistant rates of bacteria to most antibiotics and the preralence of ESBLs in old patients with lower respiratory tract infection HAP were higher than that of CAP.Imipinem,cefoperazone/sulbactam, piperacillin/tazobactam and vancomycin were the effective antibiotics to infections caused by ESBLs-producing strains.