昆明地区某三甲医院2018年老年科呼吸道感染病原菌分布及耐药性分析

目的 通过分析2018年老年科呼吸道感染的病原菌分布及耐药性，为临床治疗老年患者细菌呼吸道感染提供参考依据。方法 选择2018年1月-12月老年科呼吸道感染患者检出的病原菌共324株，进行前10位病原菌的分布及耐药性统计分析。结果 铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌以及金黄色葡萄球菌是老年人细菌性呼吸道感染检出的最常见病原菌，与其它文献报道一致，但与其它大多文献不同的是我院卡它莫拉菌的检出率在第3位，是我院老年细菌性呼吸道感染患者的主要病原菌；铜绿假单胞菌对头孢他啶、头孢吡肟、亚胺培南、环丙沙星的耐药率分别为61%、51.9%、52.4%和18.1%；肺炎克雷伯菌对头孢唑啉、头孢曲松、头孢吡肟、亚胺培南和环丙沙星的耐药率分别为45.5%、13.7%、2%、2%和7.8%；大肠埃希菌对头孢唑啉、头孢曲松、头孢吡肟、亚胺培南和环丙沙星的耐药率分别为88.9%、67.9%、28.6%、3.6%和67.9%；鲍曼不动杆菌对哌拉西林/三唑巴坦的耐药率为53.3%，对头孢曲松、头孢吡肟、亚胺培南及环丙沙星的耐药率为50%；检出率明显增多的卡它莫拉菌对临床常用的抗菌药物都保持较高的敏感性，阿奇霉素出现3.3%的非敏感率；金黄色葡萄球菌对青霉素，苯唑西林，红霉素的耐药率分别为100%、42.1%和73.7%，其对喹诺酮类抗生素及氨基糖苷类抗生素有较高的敏感性，未发现对万古霉素耐药。结论 老年患者细菌性呼吸道感染主要以革兰阴性菌为主，本地区需注意卡它莫拉菌检出率有增多趋势，常见病原菌对多数抗生素的耐药率呈上升趋势，临床需根据患者情况及药敏结果合理选择抗生素治疗。

Distribution and drug resistance of pathogens in respiratory tract infection in geriatrics department of a major hospital in Kunming in 2018

Objective To analyze the distribution and drug resistance of pathogenic bacteria of respiratory tract infections in geriatrics in 2018, so as to provide reference for clinical treatment of bacterial respiratory tract infections in geriatric patients. Methods A total of 324 strains of pathogenic bacteria were selected from patients with respiratory tract infection in geriatrics from January to December 2018. The distribution and drug resistance of the top ten pathogenic bacteria were analyzed. Results Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus were the most common pathogens detected in elderly patients with bacterial respiratory tract infections, which were consistent with other literature reports. However, unlike most other literatures, the detection rate of Moraxella catarrhalis in our hospital is the third, which is the main pathogen in elderly patients with bacterial respiratory tract infections in our hospital;The resistance rates of Pseudomonas aeruginosa to ceftazidime, cefepime, imipenem and ciprofloxacin were 61%, 51.9%, 52.4% and 18.1%, respectively. The resistance rates ofKlebsiella pneumoniae to cefazolin, ceftriaxone, cefepime, imipenem and ciprofloxacin were 45.5%, 13.7%, 2%, 2%, 7.8%, respectively. The resistance rates of E. coli to cefazolin, ceftriaxone, cefepime, imipenem and ciprofloxacin were 88.9%, 67.9%, 28.6%, 3.6% and 67.9%, respectively. The resistance rate of Acinetobacter baumannii to piperacillin/tazobactam was 53.3% and 50% to ceftriaxone, cefepime, imipenem and ciprofloxacin. The detection rate of Moraxella catarrhalis was significantly increased, and the sensitivity of Moraxella catarrhalis to commonly used clinical antibiotics was high. Azithromycin showed a 3.3% non-sensitivity rate. The resistance rates of Staphylococcus aureus to penicillin, oxacillin and erythromycin were 100%, 42.1% and 73.7%, respectively. Staphylococcus aureus was highly sensitive to quinolones and aminoglycoside antibiotics, and no vancomycin resistance was found.Conclusion Gram-negative bacteria are the main pathogens of bacterial respiratory tract infections in elderly patients. There is an increasing trend in the detection rate of Moraxella catarrhalis in this area, and the drug resistance rate of common pathogenic bacteria to most antibiotics shows an increasing trend. Antibiotics should be selected reasonably according to the patient’s condition and drug