脑血管疾病患者医院感染类型与菌谱及其耐药性分析

Analysis of the infection types and pathogens and antimicrobial resistance in nosocomial infection in patients with cerebrovascular diseases

目的探讨脑血管疾病患者医院感染发病特点和防治措施。方法回顾性调查186例脑血管疾病住院患者的医院感染类型、感染菌构成和常见病原菌耐药情况。结果医院感染类型以下呼吸道感染、泌尿系统感染和皮肤软组织感染为主。感染菌居前6位的分别是铜绿假单胞菌、酵母样菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS)。铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶和亚胺培南保持高度敏感。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)株分别占其13.33%和14.28%;耐甲氧西林金黄色葡萄球菌、耐甲氧西林CNS分别占17.65%(3/17)和43.75%(7/16)。结论脑血管疾病患者医院感染病原菌以条件致病菌为主;临床诊疗中应针对疾病特点积极采取预防和控制措施。

Objective To evaluate the characteristics and preventive measures of nosooomial infection （NI） in patients with cerebrovascular diseases. Methods Retrospective analysis was made on the infection types, infectious bacterial spectrum and antimicrobial resistance in 186 patients with cerebrovascular diseases. Results The main NI types were infection in lower respiratory tract, urinary tract and skin and soft tissue. The top six pathogens were Pseudomonas aeruginosa , yeast-like fungus, Klebsiella pneumoniae , Escherichia coli , Staphylococcus aureus and Coagulase Negative Staphylococcus. Pseudomonas aeruginosa was highly sensitive to piperacillin/tazobactam, ceftazidime and imipenem. β- lactamaseproducing rate in Klebsiella pneumoniae and Escherichia coli was 13.33% and 14.28% respectively, the resistant rate in MRSA and MRCNS was 17.65% （3/17） and 43.75% （7/16） respectively. Concluion Opportunistic pathogens are the main strains in NI in patients with cerebrovascular diseases. Preventive and control measures should be taken according to the characteristics of diseases during the clinical diagnosis and treatment.