脑卒中患者继发肺部感染病原菌耐药性探讨

Drug resistance of pathogens causing secondary pulmonary infections in stroke patients

目的探讨医院279例脑卒中合并肺部感染患者的病原菌药物敏感性,为预防和控制医院感染提供科学依据。方法无菌手法收集脑卒中患者呼吸道感染性标本;细菌培养按照临床微生物学检验的常规操作方法进行,细菌鉴定采用MicroScan AutoScan4自动微生物鉴定系统进行;药敏试验采用WHO指定的纸片扩散法,判断依据CLSI的新折点分析,药敏数据统计运用WHONET5.5软件版本分析。结果 279例脑卒中患者肺部感染标本中分离出311株病原菌,其中革兰阴性菌233株占74.9%,革兰阳性菌53株占17.0%,真菌25株占8.1%;肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌对阿米卡星、亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率<25.0%;嗜麦芽寡养单胞菌对米诺环素、磺胺甲噁唑/甲氧苄啶、左氧氟沙星耐药率分别为10.7%、17.9%、14.3%;金黄色葡萄球菌对万古霉素、替考拉宁100.0%敏感;MRSA检出率为51.2%;鲍氏不动杆菌和铜绿假单胞菌的泛耐药菌株阳性检出率分是为15.2%、11.3%。结论神经内科医师应减少肺部感染的危险因素,降低肺部感染的诱发概率;医院领导应加强抗菌药物使用的管理,提高临床医师抗菌药物处方水平,延缓细菌耐药性不断增长的趋势。

OBJECTIVE To approach the drug susceptibility of pathogens causing pulmonary infections in 279 stroke patients so as to provide scientific bases for prevention and control of nosocomial infections. METHODS The infective specimens were collected from the strike patients complicated with respiratory tract infections with the use of aseptic technique, then the bacterial culture was performed by the routine methods of the clinical laboratory microorganisms, the bacterial identification was carried out by using the MicroScan AutoScan4, the drug susceptibility testing was performed with the use of disk diffusion method specified by WHO, the data were analyzed through the latest fold points of CLSI, and the result of drug susceptibility testing was statistically analyzed by using WHONET5.5 software. RESULTS Of totally 311 strains of pathogens isolated from the infective specimens obtained from 279 stoke patients with pulmonary infections, there were 233 （74. 9%） strains of gram-negative bacteria, 53 （17. 0%） strains of gram-positive bacteria, and 25 （8. 1%） strains of fungil The K. pneumoniae, P. aeruginosa, and A. baumannii were susceptible to amikacin, imipenem, meropenem, piperacillin-tazobactam, and cefoperazone-sulbactam, with the drug resistance rates less than 25.0% the drug resistance rates of S. maltophilia to minocycline, sulfamethoxazole-trimethoprim, and levofloxacin were 10.7 %, 17.9 %, and 14.3 %, respectively% the drug susceptibility rates of S. aureus to vancomycin and teicoplanin were 100. 0%. The detection rate of MRSA was 51.2%;the detection rate of pandrug-resistant A. baumannii was 15. 2%, the panddrug-resistant P. aeruginosa was 11. 3%. CONCLUSION The clinicians in department of neurology should reduce the risk of pulmonary infections, and it is necessary for the hospital leaders to enhance the management of use of antibiotics and improve the level of antibiotics prescription so as to postpone the increasing tendency of antimicrobial resistance.