急性脑卒中并发肺部感染病原学及药物敏感性试验

Pathogens and Susceptibility of Antimicrobials in Complicated Pulmonary Infections in Patients with Acute Cerebral Strokes

目的:探索急性脑卒中并发肺部感染的病原学特点及药物敏感性,以指导临床合理选用抗菌药物。方法:前瞻性采用ATB鉴定法和药敏测试仪拟检测76例急性脑卒中并发肺部感染患者痰培养细菌学特点及药敏感特性。结果:痰培养共检出菌株171株,以G-杆菌为主(53.80%),其次为G+球菌(33.33%)和真菌(12.87%)。G-杆菌以肺炎克雷伯菌最多,其次为大肠埃希菌;G+球菌以金黄色葡萄球菌和溶血性葡萄球菌最多;真菌以白假丝酵母菌为主。药物敏感试验显示,G-杆菌对亚胺培南/西司他丁、哌拉西林/他唑巴坦最敏感,G+球菌对万古霉素最敏感,真菌对5-氟胞嘧啶和两性霉素B最敏感。结论:G-杆菌是急性卒中并发肺部感染的主要致病菌,治疗上宜根据患者个体的药敏情况及临床表现选用抗生素。

Objective： Pathogenicity and antimicrobial susceptibility of complicated pulmonary infections in patients with acute cerebral strokes have been investigated. Methods： In a prospective study of seventy-six hospitalized patients with acute cerebral strokes, complicated pulmonary infections have been observed. The pathogens were identified by ATB method in phlegm bacterial cultures, and susceptibility of pathogens to antimicrobials was determined by susceptibility tests. Results： A total of 171 strains were isolated in the phlegm bacterial cultures in the study. Out of them, 53.80% were gram negative （Gˉ） bacteria, 33.33% gram positive （G^＋ ）, and 12.87% fungi. Klebsiella and Escherichia Coil constituted the most frequent causitive Gˉ bacteria, Staphylococcus aureus and Staphylocococcus haemolyticus the Gˉ bacteria, and Candda albicans the fungi. The Gˉ bacteria were most sensitive to Imipenem/Cilastatin or Piperacillin/Tazobactam, the Gˉ bacteria to Vancomycin, and fungi to 5-Flucytosine and Amphotericin B. Conclusion：The Gˉ bacteria are major pathogens in the patients with a acute cerebral strokes who were complicated with pulmonary infections during hospitalization,and the antibiotic should be choosed according to antimicrobial susceptibility and clinical manifestation.