老年糖尿病患者医院内获得性下呼吸道感染痰培养病原学分析

目的 探讨老年糖尿病患者医院内下呼吸道感染的临床特点及病原学情况。方法 回顾性调查85例老年糖尿病合并医院获得性下呼吸道感染患者的临床资料，分析病原学及细菌耐药性的特点与糖代谢的关系。结果 老年糖尿病患者下呼吸道感染的病原菌以革兰阴性杆菌为主，占73．9％，主要为铜绿假单胞菌18．2％、肺炎克雷伯菌15．9％、大肠杆菌14．8％。2种细菌混合感染占14．1％，细菌与真菌并存占6．8％。药物敏感试验提示：革兰阴性杆菌对抗菌素的敏感性依次为头孢他啶(Ceftazidime)72．3％、氧氟沙星(Ofloxacin)70．8％、头孢曲松(Ceftriaxone)63．1％、头孢噻肟(Cefotaxime)61．5％、头孢哌酮(Cefoperazone)61．5％、头孢唑啉(Cefazolin)60．O％、哌拉西林(Piperacillin)53．8％。革兰阳性球菌对万古霉素100％敏感。对青霉素、红霉素、四环素等呈现不同程度的耐药，耐药率在55％以上。血糖控制不好、基础疾病复杂、伴有并发症的老年糖尿病患者在医院内下呼吸道感染增多，且预后不良。结论 糖尿病患者中医院获得性下呼吸道感染常见，病原菌以革兰阴性杆菌为主，应参考药物敏感试验结果并在控制血糖的基础上进行抗炎治疗。

Hospital-acquired low respiratory tract infection in elderly diabetic patients

ObjectiveTo investigate the clinical manifestati on and pathogen of hospital acquired low respiratory tract infection in elderly patients with diabetes.MethodsTo analyze retrospectively th e clinical data, the pathogens isolated from cultured sputum and the antibiotic sensitivity of bacteria in 85 elderly patients with diabetes.Results Bacilli in sputum were common in these patients(73 9%), including Pse udomonas aeruginosa (18 2%), Klebsiella pneumoniae(15 9%), Escherichia co li(14.8%), 14% complicated with 2 different bacilli, 6.8% with fungus. The bac illi sensitive rate to antibiotics was as high as 72.3% to Ceftazidime, 70.8% to Ofloxacin, 63 1% to Ceftriaxone, 61 5% to Cefoperazone or Cefoperazone, 60 .0% to Cefazolin, 53.8% to Piperacillin respectively. Cocci sensitive rate wa s 100% to Vancomycin. Uncontrolled hyperglycemia, severe basic diseases and dia betic complications were involved in the pathogenesis of hospital acquired low respiratory tract infection and the poor prognosis.Conclusion Hospital acquired low respiratory tract infection is common in elderly patient s with diabetes, and should be treated based on the antibiotic sensitivity of ba cteria and on metabolic control.