摘要
目的分析本院老年脓毒症患者血培养阳性病原菌的分布情况及其耐药特征,为提高临床老年脓毒症的诊治水平、合理使用抗菌药物提供理论依据。方法回顾性分析2018—2023年本院老年脓毒症患者血培养标本分离出的病原菌种类分布特点及耐药情况。结果共分离出292株病原菌,其中革兰阳性球菌134株(45.89%),革兰阴性杆菌119株(40.75%),真菌35株(11.99%),革兰阳性杆菌4株(1.37%)。病原菌检出率排前5位的分别为肺炎克雷伯菌(14.38%)、表皮葡萄球菌(11.99%)、鲍曼不动杆菌(10.62%)、金黄色葡萄球菌(9.93%)、大肠埃希菌(8.22%),分布科室主要是重症医学科、急诊内科和肿瘤科,基础疾病以恶性肿瘤、高血压和肺部感染最常见。肺炎克雷伯菌和鲍曼不动杆菌耐药情况严重,对临床常用抗菌药物的耐药率均高于大肠埃希菌,三种主要革兰阴性菌对头孢他啶/阿维巴坦敏感率为100%。碳青霉烯类耐药肺炎克雷伯菌和碳青霉烯类耐药鲍曼不动杆菌的检出率分别为55.56%和80.95%。亚胺培南、美罗培南、阿米卡星、头孢哌酮—舒巴坦、替加环素和多粘菌素对大肠埃希菌的抗菌活性较强,耐药率均低于15%。金黄色葡萄球菌对青霉素的耐药率在95.00%以上,耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)检出率为62.07%。万古霉素、替加环素、利奈唑胺和替考拉宁对葡糖球菌和肠球菌抗菌活性强,敏感率达100%。结论本院老年脓毒症患者分离的病原菌种类较多,以革兰阳性球菌为主。肺炎克雷伯菌和鲍曼不动杆菌耐药情况较严重,临床需根据病原菌的耐药情况合理选用抗菌药物。
Objective To study the distribution of pathogens and their antimicrobial resistance characteristics in elderly patients with sepsis in our hospital,and to provide a theoretical basis for improving the diagnosis and treatment of elderly sepsis and for the rational use of antimicrobial agents.Methods A retrospective analysis was conducted on the distribution characteristics and antimicrobial resistance of pathogens isolated from blood culture specimens of elderly sepsis patients from 2018 to 2023.Results A total of 292 strains of pathogens were isolated,including 134 strains(45.89%)of Gram-positive bacteria,119 strains(40.75%)of Gram-negative bacteria,35 strains(11.99%)of fungi and 4 strains(1.37%)Gram-positive bacilli.The top five pathogens identified were Klebsiella pneumoniae(14.38%),Staphylococcus epidermidis(11.99%),Acinetobacter baumannii(10.62%),Staphylococcus aureus(9.93%),and Escherichia coli(8.22%).These pathogens were primarily distributed in the departments of intensive care medicine,emergency internal medicine and oncology,and the most common underlying diseases are malignant tumors,hypertension,and lung infections.Klebsiella pneumoniae and Acinetobacter baumannii exhibited significant antibiotic resistance,and their resistance rates to commonly used clinical antibiotics were higher than that of Escherichia coli.The sensitivity rate of the three primary Gram-negative bacteria to ceftazidime-avibactam was 100%.The detection rates of carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii were 55.56%and 80.95%,respectively.Escherichia coli showed strong susceptibility to imipenem,meropenem,amikacin,cefoperazone-sulbactam,tigecycline,and polymyxin,with resistance rates below 15%.The resistance rate of Staphylococcus aureus to penicillin exceeded 95.00%,and the detection rate of Methicillin-resistant Staphylococcus aureus(MRSA)was 62.07%.Enterococcus faecalis and Enterococcus faecium were 100.00%susceptible to vancomycin,tigecycline,linezolid,and teicoplanin.Conclusions In our hospital,elderly sepsis patients had many pathogens isolated,mainly Gram-positive cocci.Klebsiella pneumoniae and Acinetobacter baumannii had severe resistance.Clinicians should select antibiotics based on pathogen resistance.
作者
孔娜娜
Liu Weiwei
Kong Nana;Liu Weiwei(Department of Clinical Laboratory,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)
出处
《齐齐哈尔医学院学报》
2025年第6期534-539,共6页
Journal of Qiqihar Medical University
基金
上海市浦东新区卫生健康委员会青年科技项目(PW202113-07)。
关键词
老年
脓毒症
病原菌
耐药
Elderly people
Sepsis
Pathogens
Antimicrobial resistance
