CAJ | 학술논문

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%。病原菌对氨苄西林+舒巴坦、氨曲南、四环素、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<0.05)。结论老年社区获得性肺炎感染以流感嗜血杆菌、肺炎链球菌、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。目的：分析老年社區穫得性肺炎病原體分佈及抗菌藥物耐藥狀況，探討濫用抗生素對社區穫得性肺炎病原體分佈的影響。方法隨機選取湖北省黃梅縣第二人民醫院內科2008年6月至2013年5月內科收治的218例符閤入選條件的老年患者進行病原學檢查和藥敏試驗。將病史中有濫用抗生素病史的142例患者設為濫用抗生素組，將正規用抗生素的76例患者設為正規治療組，比較兩組細菌培養暘性率和非典型病原體培養暘性率的差異性。結果218例患者中147例病原學檢查暘性，其中細菌暘性115例，佔52.8%，非典型病原體32例，佔14.7%。細菌和非典型病原體混閤感染6例，均為肺炎支原體與細菌混閤感染。有4種細菌的暘性率比較高，分彆為流感嗜血桿菌34例，佔15.6%，肺炎鏈毬菌31例，佔14.2%，肺炎剋雷伯菌29例，佔13.3%，大腸埃希菌9例，佔4.1%。流感嗜血桿菌對複方新諾明的耐藥率達64.7%，對哌拉西林的耐藥率達44.1%，對氨芐西林+舒巴坦的耐藥率達38.2%。肺炎鏈毬菌對氨芐西林+舒巴坦的耐藥率達67.7%，肺炎剋雷伯菌對氨芐西林+舒巴坦的耐藥率達61.3%，大腸埃希菌對哌拉西林的耐藥率達33.3%。病原菌對氨芐西林+舒巴坦、氨麯南、四環素、複方新諾明、哌拉西林、頭孢他啶的耐藥率高于其他抗菌藥。218例患者有濫用抗生素病史者達65.1%，濫用抗生素組和正規治療組比較，細菌培養暘性率和非典型病原體培養暘性率差異均有統計學意義(P<0.05)。結論老年社區穫得性肺炎感染以流感嗜血桿菌、肺炎鏈毬菌、肺炎剋雷伯菌、大腸埃希菌和支原體為主，這些高髮病原體對常用的抗生素已產生瞭較高的耐藥性，這可能與長期濫用抗生素有關，為瞭防止耐藥菌株的產生，要求臨床醫生在工作中閤理運用抗生素，併對病原體的分佈和耐藥性進行動態鑑測。
목적：분석노년사구획득성폐염병원체분포급항균약물내약상황，탐토람용항생소대사구획득성폐염병원체분포적영향。방법수궤선취호북성황매현제이인민의원내과2008년6월지2013년5월내과수치적218례부합입선조건적노년환자진행병원학검사화약민시험。장병사중유람용항생소병사적142례환자설위람용항생소조，장정규용항생소적76례환자설위정규치료조，비교량조세균배양양성솔화비전형병원체배양양성솔적차이성。결과218례환자중147례병원학검사양성，기중세균양성115례，점52.8%，비전형병원체32례，점14.7%。세균화비전형병원체혼합감염6례，균위폐염지원체여세균혼합감염。유4충세균적양성솔비교고，분별위류감기혈간균34례，점15.6%，폐염련구균31례，점14.2%，폐염극뢰백균29례，점13.3%，대장애희균9례，점4.1%。류감기혈간균대복방신낙명적내약솔체64.7%，대고랍서림적내약솔체44.1%，대안변서림+서파탄적내약솔체38.2%。폐염련구균대안변서림+서파탄적내약솔체67.7%，폐염극뢰백균대안변서림+서파탄적내약솔체61.3%，대장애희균대고랍서림적내약솔체33.3%。병원균대안변서림+서파탄、안곡남、사배소、복방신낙명、고랍서림、두포타정적내약솔고우기타항균약。218례환자유람용항생소병사자체65.1%，람용항생소조화정규치료조비교，세균배양양성솔화비전형병원체배양양성솔차이균유통계학의의(P<0.05)。결론노년사구획득성폐염감염이류감기혈간균、폐염련구균、폐염극뢰백균、대장애희균화지원체위주，저사고발병원체대상용적항생소이산생료교고적내약성，저가능여장기람용항생소유관，위료방지내약균주적산생，요구림상의생재공작중합리운용항생소，병대병원체적분포화내약성진행동태감측。
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 Mycoplasma pneumonia mixed with bacteria. The top four bacteria found were Hemophilies 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 agents and resistance should be monitored.