老年社区获得性肺炎病原学、药敏及抗生素滥用状况分析

目的分析老年社区获得性肺炎病原体分布及抗菌药物耐药状况，探讨滥用抗生素对社区获得性肺炎病原体分布的影响。方法随机选取湖北省黄梅县第二人民医院内科2008年6月至2013年5月内科收治的218例符合入选条件的老年患者进行病原学检查和药敏试验。将病史中有滥用抗生素病史的142例患者设为滥用抗生素组，将正规用抗生素的76例患者设为正规治疗组，比较两组细菌培养阳性率和非典型病原体培养阳性率的差异性。结果218例患者中147例病原学检查阳性，其中细菌阳性115例，占52．8％，非典型病原体32例，占14．7％。细菌和非典型病原体混合感染6例，均为肺炎支原体与细菌混合感染。有4种细菌的阳性率比较高，分别为流感嗜血杆菌34例，占15．6％，肺炎链球菌31例，占14．2％，肺炎克雷伯菌29例，占13．3％，大肠埃希菌9例，占4．1％。流感嗜血杆菌对复方新诺明的耐药率达64．7％，对哌拉西林的耐药率达44．1％，对氨苄西林＋舒巴坦的耐药率达38．2％。肺炎链球菌对氨苄西林＋舒巴坦的耐药率达67．7％，肺炎克雷伯菌对氨苄西林＋舒巴坦的耐药率达61．3％，大肠埃希菌对哌拉西林的耐药率达33．3％。病原菌对氨苄话林＋舒巴坦、氨曲南、四环索、复方新诺明、哌拉西林、头孢他啶的耐药率高于其他抗菌药。218例患者有滥用抗生素病史者达65．1％，滥用抗生素组和正规治疗组比较，细菌培养阳性率和非典型病原体培养阳性率差异均有统计学意义（P〈O．05）。结论老年社区获得性肺炎感染以流感嗜血杆菌、肺炎链球茵、肺炎克雷伯菌、大肠埃希菌和支原体为主，这些高发病原体对常用的抗生素已产生了较高的耐药性，这可能与长期滥用抗生素有关，为了防止耐药菌株的产生，要求临床医生在工作中合理运用抗生素，并对病原体的分布和耐药性进行动态监测。

Analysis on the pathogens,susceptibility and misapplication of antibiotics of community acquired pneumonia in the elderly community.

Objective To analyze the distribution and drug resistance of the pathogens of community ac- quired pneumonia, and to discuss the effect of misapplication of antibiotics on the distribution of community acquired pneumonia in the elderly community. Methods A total of 218 elderly patients in the Second People＇s Hospital of Huangmei from June 2008 to May 2013 were selected and underwent aetiology test and susceptibility test. One hun- dred and forty-two patients who had the history of misapplication of antibiotic were selected as the antibiotics misap- plication group, and 76 patients who used antibiotic regularly were enrolled as the regular treatment group. The differ- ence of positive rate of bacterial culture and the positive rate of atypical pathogens were compared. Results 147 of the 218 cases were positive in aetiology test, including 115 bacteria （52.%） and 32 atypical pathogens （14.7%）. Six cas- es were found with mixed infection of bacteria and atypical pathogens by Mycoplasrna pneumonia mixed with bacteria. The top four bacteria found were HemophiIies influenzae （34 cases, 15.6%）, Streptococcus pneumonia （31 cases, 14.2%）, Klebsiella pneumonia （29 cases, 13.3%） and Escherichia coli （9 cases, 4.1%）. Hemophilies were 64.7% resistant to Cotrimoxaxole, 44.1% resistant to Piperacilin, 38.2% resistant to Ampicil and Sulactam. Streptococcus pneumoniae were 67.7% resistant to Ampicil and Sulbactam, Klebsiella pneumoniae were 61.3% resistant to Ampicil and Sul- bactam, and Escherichia coli were 33.3% resistant to piperacillin. Pathogenic bacteria had higher resistant rates to Ampicil and Sulbactam, Aztreonam, Acm, Bactrim, Pieracillin and Ceftazidime than other antibacterial agents. 65.1%of the 218 patients had history of abused use of antibiotics. The positive rate of bacterial and atypical patho- gens showed significant differences between antibiotics misapplication group and regular treatment group, P〈 0.05. Conclusion The community acquired pneumonia for the elderly are caused mainly by Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Mycoplasma, which all have high resistance to regular antibiotics. To avoid the formation of drug-resistant strain, antibiotics should be used rationally, and the distri- bution of causative a~ents and resistance should be monitored.