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1、临床肺科杂志2011年6月第16卷第6期859老年社区获得性肺炎病原学分析陈元菁摘要目的研究老年社区获得性肺炎患者的病原体分布。方法收集2005年6月~2008年5月在我院住院的128例老年CAP患者,留取呼吸道分泌物进行细菌培养,分离鉴定细菌并进行药物敏感性试验,同时检测患者急性期和恢复期肺炎支原体、肺炎衣原体、嗜肺军团菌血清抗体。结果128例CAP患者60例(469%)病原学检查阳性,病原菌45株,其中主要为流感嗜血杆菌14株,肺炎克雷伯杆菌12株,肺炎链球菌10株。非典型病原阳性18例,主要为肺炎支原体13例,肺炎衣原体4例,3例为混合感染。流感嗜血杆菌对氨
2、苄西林耐药率为143%;肺炎链球菌对青霉素不敏感率为30%,对阿齐霉素耐药率为60%;肺炎克雷伯菌产酶率167%,对含-内酰胺酶抑制剂的复方抗生素制剂和亚胺培南敏感。结论老年患者肺炎以革兰阴性菌为优势菌株,对喹诺酮类和第3代头孢菌素具有不同程度的耐药性,对革兰阴性菌选用含有酶抑制剂的复方抗生素制剂或亚胺培南,非典型病原体的感染也占重要地位。关键词老年患者;社区获得性肺炎;病原学;耐药性CharacteristicsofEtiologyofCommunityAcquiredPneumoniainElderlyChenYuanjing(Shanghaikongjia
3、ngHospital,ShuangyangRoad480)AbstractObjectiveToinvestigatethepathogeniccausesofcommunityacquiredpneumonia(CAP)intheelderlyandtoguideexperienceantibiotictherapy.MethodsAprospectivestudywasperformedon128elderspatientswithCAPinKongJiangHospitalfromJune2005toMay2008.Sputumsampleswerecollect
4、edforculture.BacteriawereisolatedandidentifiedusingconventionalmethodsandtheirMinimumInhibitoryConcentration(MIC)weredetermined.AntibodiesofthepairedserumsamplestoMycoplasmapneumonia,Chlamydiapneumonia,andLegionellapneumophilaweredetected.ResultTheetiologyofCAPwasidentifiedin60patients.45bacter
5、ialand18atypicalpathogenswereisolated.Haemophilusinfluenzae14,Klebsiellapneumoniae12,Streptococcuspneumoniae10,Mycoplasmapneumonia13,Chlamydiapneumoniae4.In3patientsmorethanonecausalagentwerefound.ThedrugresistancerateofHaemophilusinfluenzaetoampicillinwas143%;ThenonsusceptibilityratesofStrep
6、tococcuspnenumoniaetopenicilinandazithromycinwere30%and60%;About167%ofklebsiellapneumoniaeproducedlactamases,highlysensitivetotheantibioticwithlactamasesinhibitorandImipinem.ConclusionsThemainpathogenesofpatientswithCAPinelderlywasgramnegativebacteria,highlyresistancerateofquinolonesandt
7、hirdgenerationcephalosporin,andatypicalpathogensalsoplayasignificantroleinCAP.KeywordselderlyCommunityAcquiredPneumonia;Etiologyresistancerate作者单位:200093上海,上海市控江医院内科总之,OSAHS由于反复的缺氧与复氧激发了氧化应激反structivesleepapneasyndro
