脑卒中患者下呼吸道感染革兰阴性杆菌的耐药性调查

Antimicrobial resistance of gram negative bacilli causing lower respiratory tract infection in stroke patients

目的:调查分析脑卒中患者继发下呼吸道感染革兰阴性杆菌(g-b)的耐药现状,为临床医师抗感染治疗提供参考依据。方法:212株g-b鉴定严格按照《全国临床检验操作规程》,采用常规方法进行;药敏试验采用KB法,结果依据CLSI2009-2011年规则判读。结果:脑卒中患者下呼吸道分泌物中分离的主要病原菌依次为铜绿假单胞菌(26.4%)、肺炎克雷伯菌(21.2%)、大肠埃希菌(16.0%)、鲍曼不动杆菌(14.2%)、嗜麦芽寡养单胞菌(9.9%)。以上细菌均产生了严重的耐药性,耐药率最高的抗菌药物是复方新诺明(62.5%～70.0%),铜绿假单胞菌和鲍曼不动杆菌对亚胺培南和美罗培南耐药率为17.9%～26.7%。结论:脑卒中患者继发下呼吸道感染的耐药性已十分严重,应采取针对性干预措施,遏制细菌耐药性快速增长的不良趋势。

Objective：To investigate the antimicrobial resistance of gram negative bacilli （g-b） causing lower respiratory tract infection in stroke patients and provide the reference for clinical anti-infection therapy. Method： Referring to National Guide to Clinical Laboratory Procedures, 212 g-b were identified by the routine methods. The susceptibility tests were performed by K-B methods. And the testing results were assessed according to CLSI 2009-2011 breakpoints. Result：The main pathogenic bacteria causing lower respiratory tract infection in stroke patients were Pseudomonas aeruginosa （26.4%） , K. Pneunmoniae （21.2%）, Escherichia coli （16.0%）, A. baumannii （14.2%） and Stenotrophomonos maltophilia （9.9%）. The severe antimicrobial resistance occurred in the above strains. The antibiotics with the highest resistance rates was SMZ-TMP （62. 5%- 70.0 %）. The resist ance rates of imipenem and meropenem against Pseudomonas aeruginosa and Acinetobacter baumannii varied between 17.9% and 26.7%. Conclusion：The antimicrobial resistance of g b causing lower respiratory tract infection in stroke patients was severe. Targeted interventions should be taken to restrain the adverse trends of the rapid growth of bacterial resistance.