烟台市272例老年社区获得性肺炎住院患者的病原学特点分析

目的了解60岁以上老年社区获得性肺炎(CAP)住院患者的病原谱构成、影响因素及主要病原体耐药情况。方法采用系统随机抽样的方法抽取烟台市两所综合性医疗机构2017年全年收治的老年CAP住院患者272例,对其临床资料及病原学检测结果进行回顾性分析,并对计数资料进行X²检验。结果 (1)在采集标本中共检出16种呼吸道病原体,阳性率54.41%(148/272),各类病原体中以乙型流感病毒(58/272)、肺炎克雷伯菌(48/272)、肺炎支原体(22/272)分别居病毒、细菌、非典型病原体的首位,病原体混合感染率18.38%(50/272);(2)不同年龄组中肺炎克雷伯菌、流感嗜血杆菌及肺炎支原体的检出率存在差异(P<0.05),10-12月发病的患者其病原阳性率(69/101)明显高于其他月份(X²=30.629,P<0.001);(3)患者中检出的肺炎克雷伯菌对氨苄西林(100.00%)、哌拉西林(58.33%)、头孢唑林(45.83%)等药物耐药率较高,肺炎链球菌对克林霉素(80.65%)、红霉素(100.00%)、四环素(77....

Etiological characteristics of community-acquired pneumonia in 272 elderly inpatients,Yantai

To investigate the pathogenic spectrum, influence factors and drug resistance of main pathogens in elderly patients over 60 years old with community-acquired pneumonia(CAP). Methods 272 elderly CAP inpatients admitted to two comprehensive medical institutions in Yantai City in the whole year of 2017 were retrospectively analyzed for their clinical data and pathogenic test results. The method of systematic random sampling was used and X2 test for enumeration data. Results(1) A total of 16 respiratory pathogens were detected in 272 samples, whose positive rate was 54.41%(148/272). Influenza B virus(58/272), Klebsiella pneumoniae(48/272) and Mycoplasma pneumoniae(22/272) were the top pathogens of viruses, bacteria and atypical pathogens. The mixed infection rate of pathogens was 18.38%(50/272).(2) The detection rates of Klebsiella pneumoniae, Hemophilus influenzae and Mycoplasma pneumoniae in different age groups were different(α=0.05). The positive rate of pathogens in patients with onset from October to December(69/101) was significantly higher than that in other months(X2=30.629, P=0.000).(3) The drug resistance rates of Klebsiella pneumoniae to ampicillin(100.00%), piperacillin(58.33%) and cefazolin(45.83%) were higher, and the drug resistance rates of Streptococcus pneumoniae to clindamycin(80.65%), erythromycin(100.00%) and tetracycline(77.42%) were higher. Conclusion Influenza virus is the main pathogen of elderly CAP inpatients over 60 years old in Yantai City. Mixed infection accounts for a high proportion and its composition is complex. The main pathogenic bacteria have high resistance to commonly used antibiotics. For elderly CAP inpatients, multi-pathogenic combined detection should be carried out to provide basis for clinical treatment.