CAJ | 학술논문

目的：探讨老年痴呆合并社区获得性肺炎（CAP）患者与老年痴呆合并医院获得性肺炎（HAP）患者，在微生物菌株培养的菌群分布情况及其对抗菌药物的使用敏感性方面进行比较，为临床诊治提供参考依据。方法选择2012年7月至2013年12月上海市金山区众仁老年护理医院收治的53例老年痴呆合并CAP患者，和同期入住在该院老年痴呆科病房的79例老年痴呆合并HAP患者，共132例。所有老年痴呆合并肺炎患者痰液标本留取后，立即送检，培养出微生物菌株，分析在病原学、治疗及预后方面的差异。结果132例患者中，老年痴呆合并CAP组53例（40.2%），合并HAP组79例（59.8%）。菌株分布显示，CAP组前3位为肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌，HAP组前3位为金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌。药物敏感性方面，对铜绿假单胞菌抗菌活性较高的抗生素为阿米卡星、氨曲南，对肺炎克雷伯菌抗菌活性较高的抗生素为哌拉西林/三唑巴坦、亚胺培南，对金黄色葡萄球菌和肺炎链球菌抗菌活性较高的抗生素为万古霉素、利奈唑胺。HAP组病情较CAP组严重，合并症、死亡率均高于CAP组。结论 CAP组患者临床表现不典型，多因老年痴呆表现而入院，而合并HAP组则以发热和突发身体功能状态或意识改变最为明显，应加强临床观察；提高微生物培养的送检率，并根据药敏试验结果调整抗菌药物，采取针对性的抗菌药物治疗。
목적：탐토노년치태합병사구획득성폐염（CAP）환자여노년치태합병의원획득성폐염（HAP）환자，재미생물균주배양적균군분포정황급기대항균약물적사용민감성방면진행비교，위림상진치제공삼고의거。방법선택2012년7월지2013년12월상해시금산구음인노년호리의원수치적53례노년치태합병CAP환자，화동기입주재해원노년치태과병방적79례노년치태합병HAP환자，공132례。소유노년치태합병폐염환자담액표본류취후，립즉송검，배양출미생물균주，분석재병원학、치료급예후방면적차이。결과132례환자중，노년치태합병CAP조53례（40.2%），합병HAP조79례（59.8%）。균주분포현시，CAP조전3위위폐염련구균、금황색포도구균、류감기혈간균，HAP조전3위위금황색포도구균、동록가단포균、폐염극뢰백균。약물민감성방면，대동록가단포균항균활성교고적항생소위아미잡성、안곡남，대폐염극뢰백균항균활성교고적항생소위고랍서림/삼서파탄、아알배남，대금황색포도구균화폐염련구균항균활성교고적항생소위만고매소、리내서알。HAP조병정교CAP조엄중，합병증、사망솔균고우CAP조。결론 CAP조환자림상표현불전형，다인노년치태표현이입원，이합병HAP조칙이발열화돌발신체공능상태혹의식개변최위명현，응가강림상관찰；제고미생물배양적송검솔，병근거약민시험결과조정항균약물，채취침대성적항균약물치료。
Objective To compare the distribution of bacterial strains and sensitivity to antimicrobial agents in cultured sputum from the senile dementia patients with community-acquired pneumonia (CAP) and with hospital acquired pneumonia (HAP) in order to provide a reference for clinical diagnosis and treatment. Methods A total of 132 senile dementia patients with pneumonia admitted in our hospital from July 2012 to December 2013 were enrolled in this study. Fifty-three of them suffered from CAP and the rest 79 from HAP. After their sputa were collected, the specimens were immediately inspected and cultured for microbial strains detection. The distribution of the obtained bacterial strains and sensitivity to antimicrobial agents were analyzed. The differences in pathogens, treatment and prognosis were compared between the 2 groups. Results The percentage of the patients suffering from CAP was 40.2%while that of those from HAP was 59.8%. The top 3 strains were Streptococcus pneumoniae (SPN), Staphylococcus aureus (SAU) and Haemophilus influenzae (HIN) for the dementia patients with CAP, and SAU, Pseudomonas aeruginosa (PAE) and Klebsiella pneumoniae (KPN) for those with HAP. In terms of antibiotic sensitivity, the most effective antibiotics against PAE were amikacin and aztreonam, those against KPN were piperacillin/tazobactam and imipenem, and those against SAU and SPN were vancomycin and linezolide. The condition was severer in the patients with HAP than those with CAP, and the incidences of complications and mortality were also higher in the former than the latter. Conclusion The patients of CAP group have no typical clinical manifestations, and most of them are hospitalized due to senile dementia’s symptoms, while those of HAP group are manifested with fever, attack of body function or consciousness. We should strengthen the clinical observation, improve the inspection rate of microbial cultures, and adjust the antimicrobials according to the results of susceptibility test to offer appropriate antibacterial treatment.