医院老年患者败血症诱因与病原菌耐药性分析

目的探讨医院老年患者败血症的诱因以及病原菌耐药性。方法选择我院1999年3月~2004年6月住院老年患者败血症病例30例,回顾性分析其诱因、病原菌分布及其对抗菌药物的耐药情况。结果基础疾病:2型糖尿病10例次(占33.33%),心血管疾病9例次(占30.00%),肾功能不全和脑血管意外各5例次;在发病前7例(23.33%)施行了穿刺导管深静脉留置;41株病原菌中G 菌6株(14.6%),G-菌27株(65.9%),真菌8株(19.5%);病原菌分布老年组真菌比例高于非老年组(P=0.05);对G-杆菌敏感性良好的药物是哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南/西司他丁、左氧氟沙星、头孢曲松;而耐药性较高的是磺胺甲噁唑/甲氧苄啶、氨苄西林;真菌对制霉菌素、两性霉素B敏感。结论基础疾病较多、各种侵袭性操作、尤其是静脉导管留置是医院老年患者败血症的诱因;G-菌是主要致病菌;老年组真菌比例明显高于非老年组;哌拉西林/他唑巴坦、头孢哌酮/舒巴坦,亚胺培南/西司他丁是良好的治疗药物。

Risk Factors and Pathogenic Drug Resistance of Elderly Patients with Septicemia in Hospital

OBJECTIVE To investigate the risk factors and pathogenic drug resistance of elderly patients with(septicemia) in hospital.METHODS Data were collected from the 30 cases of elderly patients with septicemia in(hospital) from Mar 1999 to Jun 2004.A retrospective study was made for risk factors,pathogen distribution and(antimicrobial) resistance.RESULTS Their underlying diseases were as follows: 10 cases of diabetes mellitus((33.33%),) 9 cases of(cerebrovascular) diseases(30.00%),5 cases of renal dysfunction and 5 cases of cerebral (vascular) stroke,(respectively).Intravenous indwelling catheter was made in 7 cases(23.33%).Among 41 strains of pathogens,there were 6 strains of G~ ones(14.6%),27 strains of G~-(65.9%),and 8 cases of fungi((19.5%).) Fungus ratio in elderly group was higher than that of non-elderly group(P0.05).The drugs which showed(sound)(antimicrobial) effect to major G~-bacilli were: piperacillin/tazobactam,cefoperazone/sulbactam,(imipenem)/(cilastatin),levofloxacin,and ceftriaxone.But sulfamethoxazole/trimethoprim and ampicilllin showed highly resistant.Ceftazidime was relatively sensitive to(Pseudomonas) aeruginosa and Acinetobacter.Fungus was sensitive to(fungicidin) and amphotericin B.(CONCLUSIONS) Underlying diseases,various kinds of invasive manipulation,(especially) intravenous indwelling catheter are the risk factors of elderly septicemia in hospital.G~-bacteria are the major pathogens.Fungus ratio in elderly group is significantly higher than that of non-elderly.Some drugs have satisfactory antimicrobial effect,for example piperacillin/tazobactam,cefoperazone/sulbactam,and imipenem/(cilastatin).