脑卒中相关性肺炎病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing pneumonia in stroke patients

目的分析急性脑卒中患者卒中相关性肺炎(SAP)的病原菌分布及耐药性,为合理应用抗菌药物提供依据。方法分析医院2007年11月-2011年6月医院急性脑卒中患者卒中相关性肺炎的痰培养和药敏试验结果,探讨SAP的病原学和耐药性。结果卒中相关性肺炎456株病原菌中,以革兰阴性杆菌为主占67.3%,革兰阳性球菌占18.2%,真菌占14.5%,病原菌的耐药率普遍较高,大肠埃希菌和肺炎克雷伯菌的ESBLs检出3株,未检出耐甲氧西林金黄色葡萄球菌(MRSA);革兰阴性杆菌对亚胺培南的耐药率较低,金黄色葡萄球菌、表皮葡萄球菌和肠球菌属对万古霉素均未出现耐药株。结论卒中相关性肺炎的病原菌多为条件致病菌,且常为多药耐药菌,临床应重视病原学检查,指导临床合理用药,降低卒中患者的死亡率。

OBJECTIVE To analyze the distribution and the drug resistance of pathogens from acute stroke patients with stroke associated pneumonia（SAP）,in order to provide evidence for reasonable use of antibiotics.METHODS The results of sputum culture and drug susceptibility testing for the acute stroke patients with SAP from Nov 2007 to Jun 2011 were analyzed,the etiology of SAP and the drug resistance were explored.RESULTS Of 456 strains of pathogens causing SAP,gram-negative bacilli occupied 67.3%,gram-positive cocci occupied 18.2%,the fungi occupied 14.5%,the drug resistance rates of the pathogens were relatively high,there were 3 strains of ESBLs-producing Escherlchia coli and Klebsiella pneumoniae isolated,no strains of meticillin-resistant Staphylococci were detected;the drug resistance rates of gram-negative bacilli to imipenem were relatively low,the strains of S.aureus,S.epidermidis,and Enterococcus resistant to vancomycin were not found.CONCLUSION The main pathogens causing stroke associated pneumonia are opportunistic pathogenic bacteria,which are always multidrug-resistant;it is necessary to focus on the etiology examination and the rational use of antibiotics so as to reduce the mortality of the stroke patients.