急性卒中后感染调查与病原学分析

Survey of acute post-stroke infection and analysis of etiology

目的调查急性卒中住院患者感染发生率、部位、主要病原菌及其对抗菌药物的敏感性。方法制定急性卒中后感染调查表,对545例急性卒中住院患者(发病时间≤2周)的感染发生率及感染部位进行调查;同时对感染患者的病原菌培养和药物敏感试验结果进行分析。结果急性卒中后感染发生率为18.5%;感染部位主要为呼吸系统、泌尿系统;急性卒中后肺炎的发生率为11.0%;革兰阴性菌占67.5%,主要有大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌;革兰阳性菌占25.3%,主要为金黄色葡萄球菌;真菌占7.2%;革兰阴性杆菌敏感的抗菌药物主要有亚胺培南、阿米卡星、奈替米星和妥布霉素,金黄色葡萄球菌敏感的抗菌药物主要有呋喃妥因、去甲万古霉素和替考拉宁;大肠埃希菌及肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)检出率分别为50.0%、46.2%;金黄色葡萄球菌全部为耐甲氧西林金黄色葡萄球菌(MRSA)。结论急性卒中后感染发生率较高,主要发生在呼吸系统及泌尿系统,致病菌多为条件致病菌,以革兰阴性杆菌最常见。

OBJECTIVE To investigate the incidence of acute post-stroke infection in patients with acute stroke,the distribution of infection sites,the major pathogenic bacteria and their antimicrobial susceptbility.METHODS We consecutively recruited 545 acute stroke patients admitted to the hospital（onset of≤2 weeks）,the incidence and the infection sites were investigated,and the results of pathogen culture and drug susceptibility test were analyzed.RESULTS The incidence of acute post-stroke infections was 18.5%;the major infection sites were respiratory system and urinary system;the incidence of pneumonia after acute stroke was 11.0%.Of the pathogenic bacteria cultured,gram-negative bacteria accounted for 67.5%,which were mainly Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa;gram-positive bacteria accounted for 25.3%,which were mainly Staphylococcus aureus isolates;fungi accounted for 7.2%.Gram-negative bacilli were mainly susceptible to imipenem,amikacin,netilmicin and tobramycin;Staphylococcus aureus was mainly susceptible to nitrofurantoin demethylvancomycin and teicoplanin;ESBLs-producing rates of E.coli and K.pneumoniae were 50.0% and 46.2%,respectively;S.aureus strains were all methicillin-resistant S.aureus（MRSA）.CONCLUSION The incidence of infection after acute stroke is high.Most of the pathogenic bacteria are opportunistic pathogens among which gram-negative bacilli are the most common.