脑卒中患者医院获得性肺炎病原菌分布及耐药性分析

Distribution of Pathogens Causing Hospital-acquired Pneumonia in Patients with Stroke and Drug Resistance

目的分析脑卒中患者医院获得性肺炎病原菌的分布特点及耐药性,为临床使用抗菌药物提供参考。方法对医院2007年1月-2009年12月神经内、外科脑卒中住院患者3408例进行医院感染监测,将发生医院获得性肺炎的102例患者痰液或下呼吸道分泌物进行细菌鉴定和体外药敏试验,并进行分析。结果医院获得性肺炎发生率为2.99%,在102例医院获得性肺炎患者中,共检出病原菌159株,其中革兰阳性球菌40株(25.16%),以金黄色葡萄球菌最多见,其次为粪肠球菌和溶血葡萄球菌;革兰阴性杆菌101株(63.52%),主要为鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌等;真菌18株(11.32%),主要为白色假丝酵母菌和近平滑假丝酵母菌,金黄色葡萄球菌对青霉素、红霉素高度耐药,对万古霉素、多西环素、美罗培南敏感,耐甲氧西林金黄色葡萄球菌8株,对所有β-内酰胺类抗菌药物呈高度耐药;革兰阴性菌对美罗培南敏感度较高,对三代头孢菌素及喹诺酮类抗菌药物耐药率>50.00%。结论脑卒中患者医院获得性肺炎的主要病原菌是革兰氏阴性杆菌,病原菌对抗菌药物存在多药耐药性,临床应根据药敏试验结果选择抗菌药物。

OBJECTIVE To analyze the distribution and drug resistance of pathogens causing hospital-acquired pneumonia（HAP） in stroke patients,and provide references for proper clinical application of antibiotics.METHODS A total of 3408 patients with stroke hospitalized from Jan 2007 to Dec 2009 in neurologic department were monitored,and their sputum and secretions of the lower respiratory tract were cultured.The bacterial identification and drug sensitivity test were performed and analyzed.RESULTS During this period,the incidence of HAP was 2.99%.Totally 159 bacterial pathogens causing HAP were identified,in which Gram-positive cocci were 40（25.16%） strains.Staphylococcus aureus ranked the first,followed by Enterococcus faecalis and S.haemolyticus.One hundred and one strains were Gram-negative bacteria（63.52%）,including Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae and so on.Eighteen（11.32%） strains were fungi,mainly including Candida albicans and C.parapsilosis.The S.aureus was highly resistant to penicillin and erythromycin,and sensitive to vancomycin,doxycycline,and meropenem.Eight strains were meticillin-resistant S.aureus,which were highly resistant to β-lactam antibiotics.Aminoglycosides,macrolides,and quinolones were also showed resistance in different levels.Gram-negative bacilli were sensitive to meropenem,and the drug-resistance to the third generation cephalosporins and quinolones was more than 50.00%.CONCLUSION Gram-negative pathogens are predominant in HAP in stroke patients.The emergence of multi-drug resistance is common in pathogenic bacteria,the antibiotics should be selected in clinics according to the result of drug susceptibility test.