急性脑血管疾病患者医院感染的病原学分析

Analysis of pathogenic bacteria causing nosocomial infections in patients with acute cerebrovascular disease

目的分析急性脑血管疾病患者医院感染的病原学特点及相关因素,为预防医院感染提供依据。方法回顾性分析医院收治的200例急性脑血管疾病患者的临床资料,统计分析患者的感染率、感染部位、病原菌分布及其耐药性。结果入选的200例急性脑血管疾病患者中发生医院感染32例,感染率为16.00%,男性18例,感染率为16.07%;女性14例,感染率为15.91%,差异无统计学意义;感染部位以呼吸道为主,46.88%,其次为泌尿道、皮肤软组织、胃肠道和五官,分别占18.75%、15.62%、12.50%和6.25%;采集的42份标本中阳性标本34份,阳性率为80.95%;分离出39株病原菌,其中革兰阴性菌24株占61.54%,革兰阳性菌12株占30.77%,真菌3株占7.69%,前5位病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌,分别占30.77%、17.95%、15.38%、15.38%、12.82%;革兰阴性菌对亚胺培南敏感,革兰阳性菌对万古霉素敏感,真菌对氟康唑敏感。结论针对发生医院感染的患者,应及时做好药敏试验,根据药敏试验结果选用敏感的抗菌药物,并提供相应的治疗及护理。

OBJECTIVE To analyze the characteristics of pathogenic bacteria and correlative factors for the nosocomial infections in patients with acute cerebrovascular disease （ACVD） SO as to provide basis for the prevention of nosocomial infections. METHODS The clinical data of 200 patients with ACVD who were treated in the hospital were retrospectively analyzed, and the infection sites, distribution and drug resistance of the pathogenic bacteria were investigated. RESULTS Of 200 patients with ACVD investigated, the nosocomial infections occurred in 32 cases with the infection rate of 16. 00%, among which there were 18 （16. 07%） cases of male and 14 （15.91%） cases of female, the difference was not statistically significant; the main infection site was the lower respiratory tract （46.88 % ）, followed by the upper respiratory tract （18.75 % ）, urinary tract（15.62 % ）, skin soft tissue（12. 50%）, gastrointestinal tract（12.50%） and facial features（6.25%）. There were 34 positive samples from 42 samples. Totally 39 strains of pathogens were isolated, including 24 （61. 54%） strains of gram-negative bacteria, 12 （30.77%） strains of gram-positive bacteria, and 3 （7.69 %） strains of fungi. Pseudornonas aeruginosa, Klebsiella pneumoniae , Staphylococcus aureus , Staphylococcus epidermidis , and Escherichia coli were the top 5 species of pathogens, accounting for 30.77%, 17. 95% ,15.38% ,15.38%, and 12.82%, respectively; the gramnegative bacteria were susceptible to imipenem, the gram-positive bacteria were susceptible to vancomycin,and the fungi were susceptible to fluconazole. CONCLUSION It is necessary for the patients with nosocomial infections to perform the drug susceptibility testing in a timely manner and use antibiotics on the basis of drug susceptibility testing result so as to provide appropriate treatment and nursing.