ICU 114例脑卒中伴发肺部感染患者的病原菌和耐药性特点分析

Analysis of the pattern and resistance of pathogen bacteria isolated from acquired hospital pulmonary infection in 114 patients with stroke in ICU

目的:分析脑卒中伴发肺部感染患者感染菌的菌谱分布和耐药性特点,以指导临床合理使用抗菌药物。方法:回顾性分析2008年12月-2010年12月我院ICU114例脑卒中伴发肺部感染患者的痰病原菌细菌谱,并对药敏结果进行分析。结果:共检出病原菌347株,其中革兰阴性菌240株,占69.2%;革兰阳性菌57株,占16.4%;真菌50株,占14.4%。其中革兰阴性菌最主要的病原菌依次是铜绿假单胞菌(13.8%)、嗜麦芽窄食假单胞菌(13.8%)、肺炎克雷伯菌(12.4%)、大肠埃希氏菌(7.8%)、阴沟肠杆菌(6.3%)、鲍曼不动杆菌(4.6%)、洋葱伯克霍尔德菌(4.0%);其中铜绿假单胞菌和鲍曼不动杆菌对抗菌药物的耐药性显著增加,并出现多重耐药和泛耐药菌株;产ESBLs的肺炎克雷伯菌与大肠埃希氏菌分别占53.4%和37.0%;在全部检测的革兰阴性菌菌株中,亚胺培南、哌拉西林/他唑巴坦、环丙沙星、头孢吡肟、头孢他啶的敏感性分别为60.8%、57.9%、57.1%、51.3%和44.2%。革兰阳性菌中,葡萄菌属所占比例较高(13.8%);葡萄菌属和肠球菌属对利奈唑胺、万古霉素保持高度敏感性。结论:脑卒中伴发肺部感染痰病原菌以革兰阴性菌为主,特别是多重耐药的铜绿假单胞菌和嗜麦芽窄食假单胞菌更显著。念珠菌感染检出率也较高,这些都对抗菌药物的合理应用提出了更高的要求。

Objective：To study the changes of pathogen bacteria and their antibiotic resistance in patients with stroke accompanied with acquired hospital pulmonary to guide rational use of antimicrobial drugs.Method：The clinical data of 114 stroke patient with acquired hospital pulmonary infection admitted to ICU between December 2008 and December 2010 were retrospectively analyzed. The pattern of pathogen bacteria and resistance to antimicrobial agents were evaluated.Result：Of the 347 pathogens,240（69.2%） were gram-negative bacteria;including P.aeruginosa（13.8%） ,S.maltophlia（13.8%） ,K.pneumoniae（12.4%） ,E.coli（7.8%） ,E.cloacae（6.3%） ,A.baumannii（4.6%） ,B.cepacia（4.0%） . fifty-seven（16.4%） were gram-positive bacteria;50（14.4%） were fungi. These gram-negative bacteria were the leading pathogens. The resistance of P.aeruginosa and A.baumannii increased in recent two years. Some multiple-resistant and pan-resistant bacteria were identified. The prevalence of ESBLs-producing K.pneumoniae and E.coli were 53.4% and 37.0%,respectively. The sensitivity of Imipenem,Piperacillin-tazobactam,Ciprofloxacin,Cefepime and Ceftazidme was 60.8%,57.9%,57.1%,51.3% and 44.2% in gram-negetive bacterial. The prevalence of Staphylococcus（13.8%） was higher in gram-positive bacteria. Staphylococcus and Enterococcus were highly susceptible to vancomycin and linezolid.Conclusion：Gram-negative bacteria are the major pathogens of acquired hospital pulmonary infection in stroke patients. Multiple-resistant P.aeruginosa and S.maltophlia were most common and Candida was also commonly detected. It needs higher requirements for reasonable application of antimicrobial agents put forward.