摘要
目的探讨老年重症肺炎并机械通气（mechanical ventilation，MV）后再感染呼吸机相关性肺炎（ventilatorassociated pneumonia，VAP）病原学及其变化。方法对34例老年重症社区肺炎入院时和及其VAP发生后，获取下呼吸道分泌物行定量培养、药物敏感性与ESBLs检测。结果①病原：人院时以G-杆菌为主；VAP发生时，G-杆菌由75％增加到87％，其中，非发酵类细菌病原检出率也由24％上升至37％。ESBLs检出率由32％上升至47％；混合感染和“二重感染”分别由12％、9％上升至59％和35％。②对常用抗生素的药物敏感性试验：人院时G^-杆菌菌株，除对亚胺培南无耐药外，含酶抑制剂抗生素、头孢他啶，阿米卡星、拉氧头孢耐药率在20％～30％；对其余三代头孢和哌拉西林、环丙沙星耐药率为40％～50％；而VAP时G-杆菌菌株，则出现了对亚胺培南耐药菌株，耐药率的高低与入院菌株趋势大致相似，但增加12％～20％；产ESBLs菌株除亚胺培南、含酶抑制剂抗生素、拉氧头孢外，比非产ESBLs菌株耐药率高30％～50％。③病死率53％。结论出境老年重症CAP及其VAP病原均以G-杆菌为主和较高的ESBLs检出率，VAP时非发酵类细菌病原、白色念珠菌比例和ESBLs检出率均大幅增加，老年重症CAP及其VAP在抗感染治疗及抗生素选用时应充分考虑病原学的以上特点。
Objective To discuss the etiological changes in old patients with severe community acquired pneumonia and re-infection caused by ventilator-associated pneumonia. Methods Thirty-four old patients with severe community acquired pneumonia were included. The sputum from lower respiratory tract was collected and quantitatively cultured. The antibiotic susceptibility was detected with disk diffusion method, and extended spectrum β lactamases （ESBLs） were measured by E test. Results On admission, gram-negative bacilli （GNB） was the primary pathogen. When ventilator-associated pneumonia （VAP） occurred, GNB increased from 75% to 87%. The detection rate of non-fermentative bacilli increased from 24% to 37%, and the rate of ESBLs also increased from 32% to 47%. The incidence of mixed infection and secondary infection respectively increased from 12% to 59% and 9% to 35%. On admission, GNB was sensitive to imipenem. The drug resistance rate of GNB to antibiotics （lactamase inhibitor, ceftazidime, amikacin and latamoxef） was 20% to 30%, and that to the other 3th cephalosporin, piperacillin and ciprofloxacin was 40% to 50% ; When VAP occurred, the drug resistance isolates to imipenem appeared. The trend of the resistance rate was similar with admission but the rate increased by 12% to 20%. Except for the isolates to imipenem, antibiotics with lactamase inhibitor and latamoxef, the resistance rate of ESBLs producing strains was 30% to 50%, higher than that of non-ESBLs- producing strains. The mortality was 53%. Conclusion Severe CAP and VAP in old patients were characterized by gram-negative bacilli and high detection rate of ESBLs. The detection rate of non-fermentative bacilli, Candida albicans and ESBLs increased greatly when VAP occurred. The above characteristics of pathogens should be fully considered during anti-infection and antibiotics treatment in old patients with severe communityacquired pneumonia complicated by ventilator-associated pneumonia.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2007年第20期1988-1991,共4页
Journal of Third Military Medical University
基金
广州市科委攻关引导项目(00Z-E0261)~~
关键词
老年重症社区获得性肺炎
呼吸机相关性肺炎
病原
药物敏感性
aged
severe community acquired pneumonia
ventilator associated pneumonia
pathogen
antimicrobial susceptibility testing
