老年痴呆合并肺炎患者痰培养及药敏分析

Sputum culture and antibiotic susceptibility for senile dementia patients with pneumonia

摘要:

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。

Abstract:

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.