重症脑卒中后继发感染患者病原菌及预后的临床观察

Clinical observation of pathogenic bacteria causing secondary infections in patients after severe cerebral stroke

目的观察重症脑卒中后继发感染患者的病原菌、药敏率及预后的特点,为临床工作提供支持。方法应用回顾性研究,观察181例重症脑卒中后继发感染的患者,进行病原菌种类统计,观察药敏情况及预后的影响。结果 181例重症脑卒中后继发医院感染患者,其中发生肺部感染146例,泌尿系感染19例,其他感染16例;共检出病原菌183株,主要为真菌55株占30.5%,克雷伯菌属39株占21.3%和大肠埃希菌32株占17.5%;克雷伯菌属对亚胺培南的敏感率为97.4%,大肠埃希菌对亚胺培南的敏感率为100.0%;患者不同住院时间医院感染率,差异有统计学意义(P<0.05);死亡17例。结论重症脑卒中后继发感染临床多见,临床治疗及护理中要严格无菌操作,对感染患者及时进行细菌培养及耐药性检测,对指导临床合理用药具有重要意义。

OBJECTIVE To study clinical characteristics of pathogenic bacteria, drug resistance and prognosis of the patients with secondary infections after severe cerebral stroke, so as to accumulate clinical experience. METHODS A total of 181 patients with secondary infections after severe cerebral stroke were studied as observation group. The bacterial species, drug susceptibility testing results, and the prognosis were observed in the observation group. RESULTS Of 181 patients with secondary infections after severe stoke,there were 146 cases of pulmonary infections, 19 cases of urinary tract infections, and 16 cases others~ a total of 183 strains of pathogens were isolated, including 55 （30.5%） strains of fungi, 39 （21.3~） strains of Klebsiella , and 32 （17.5%）strains of Escherichia coli, the drug susceptibility rate of Klebsiella to imipenem was 97.4%, the drug susceptibility rate of E. coli to imipenem was 100. 0% the difference in the incidence of nosocomial infections in the patients with various hospital stay was statistically significant （P〈0. 05）;17 cases died in this group. CONCLUSION The secondary infection is common in the patients with severe cerebral stoke, it is necessary to perform strict aseptic operation during the clinical treatment and nursing and carry out bacterial culture and detection of drug resistance, which has great significance in guiding the reasonable use of antibiotics.