脑出血患者继发医院感染的病原菌抗药性监测

Antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with cerebral hemorrhage

目的探讨收治入院的脑出血患者继发医院感染的临床特点及致病菌耐药性,为防范脑出血患者继发医院感染和感染控制提供科学的参考资料。方法调查总结2009年1月-2012年6月收治的脑出血患者的病历资料;感染细菌分离及鉴定严格按照《全国临床检验操作规程》进行;药敏检测方法和药敏结果判读采用CLSI规定的K-B法及折点进行。结果 2901例脑出血患者中发生医院感染275例,感染率为9.5%;医院感染部位以下呼吸道为主占58.2%,其次是尿路感染占22.8%;共检出病原菌347株,其中革兰阴性杆菌占72.9%,革兰阳性球菌20.2%,真菌6.9%;耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌耐药率分别达到10.6%和15.8%;耐甲氧西林葡萄球菌(MRS)检出率为44.4%。结论脑出血住院患者易继发医院感染,感染病原菌耐药性日益增强,医院务必制定干预措施,加强环节管理和执行力度,有效地预防与控制医院感染。

OBJECTIVE To explore the clinical characteristics and antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with cerebral hemorrhage and provide the scientific reference for prevention and control of it. METHODS The retrospective review was performed for the clinical data of hospitalized patients with cerebral hemorrhage from Jan. 2009 to Oct. 2012. Bacterial isolation and identification were performed according to National Guide to Clinical Laboratory Procedure. Susceptibility testing was carried out by K-B methods recommended by CLSI. The testing results were assessed. RESULTS Totally 275 cases of nosoeomial infections were found among 2901 patients with cerebral hemorrhage. The infection rate was 9.5%. The infection sites were mostly the respiratory tract （58.2%）, followed by the urinary tract （22.8%）. A total of 347 pathogenic bacteria were isolated, including the gram-negative bacilli （72.9%）, gram-positive cocci （22.2 %） and fungi （6. 9%）. The susceptibility testing results indicated that the majority of pathogenic bacteria were resistant to clinical commonly used antibiotics in varying degree. The isolating rate of imipenem resistant Pseudo- monas aeruginosa and Acinetobacter baumannii arrived at 10.6% and 15.8%, respectively. The detection rate of methicillin-resistant Staphylococci （MRS） was 44. 4%. CONCLUSION Nosocomial infections in patients with cerebral hemorrhage has a high incidence rate. The antimicrobial resistance is increasingly on the rise. The com- prehensive measures should be adopted to prevent and control the incidence of it.