关键词：肺心病；呼吸道感染；不动杆菌感染；微生物敏感性试验
摘要 目的 了解老年慢性肺心病患者下呼吸道不动杆菌感染的致病特点和对抗生素的敏感性。 方法 对34例老年慢性肺心病患者的临床特点、痰细菌培养及药敏试验进行回顾性分析。 结果 老年慢性肺心病下呼吸道不动杆菌感染居同期136例肺心病下呼吸道感染的首位，老年、有较严重基础病和并存症、有多种抗生素、激素或免疫抑制剂的应用史是引起不动杆菌下呼吸道感染的危险因素，其临床症状严重，混合感染率高(52.9%)，院内感染率高(29.4%)，病死率高(26.5%)。不动杆菌对多种抗生素有不同程度的耐药性，硝酸盐阴性不动杆菌比洛菲不动杆菌的致病性强。 结论 老年肺心病患者下呼吸道不动杆菌感染的预后不良，治疗的关键应根据细菌培养和药敏试验选择敏感抗生素。
Clinical analysisof Acinetobacter infection of the lower respiratory tract in the elderly with chronicpulmonary heart disease
Wang Yan , Chen Guangjin, LiYunsheng, et al. Department of Respiration, Tianjin Medical University GeneralHospital, Tianjin 300052
Abstract Objective To analyze the clinicalmanifestations and antibiotic susceptibilities of Acinetobacter infection of the lowerrespiratory tract in the elderly patients with chronic pulmonary heart disease. Methods Thirty-four cases of elderlychronic pulmonary heart disease hospitalized in recent 5 years were retrospectivelyanalyzed. Susceptibilities to antibiotics were assessed by the Kirby-Bauer disk diffusionmethod on M-H agar and minimal inhibitory concentration (MIC) by the dilution test. Results The incidence of Acinetobacterinfection was higher than before and accounted for 25.0% of total infections in the sameperiod. Its clinical manifestations were serious, with high mixed infection rate (52.9%),hospital-acquired infection rate (29.4%) and fatality rate (26.5%). The strains ofAcinetobacter were multiresistant and were susceptible to ciprofloxacin, imipenem, ceftazidime, piperacillin and ticarcillin/clavulanate. Conclusions The prognosis of Acinetobacter infection of the lowerrespiratory tract in the elderly with chronic pulmonary heart disease is poor. Successfultreatment with antibiotics should be based on the antibiotics susceptibilities.
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