脑卒中患者医院感染病原学及耐药性分析

The analysis of pathogen and drug resistance of nosocomial infection in patients who suffered from stroke

目的探讨脑卒中患者医院感染病原体和耐药性机制,为临床预防医院感染以及治疗提供依据。方法选择2009年1月-2012年12月医院收治的3 941例脑卒中患者作为研究对象,对其医院感染病原体及耐药性进行分析,细菌鉴定采用法国生物梅里埃公司所提供的API20E鉴定系统,药敏试验采用K-B纸片进行,采用SPSS15.0进行统计分析。结果 3 941例脑卒中患者发生医院感染398例,感染率10.10%;检出病原体398株,革兰阴性菌212株、真菌98株、革兰阳性菌76株及非典型病原体12株,分别占53.27%、24.62%、19.10%及3.01%,位于前3位病原体分别为大肠埃希菌、热带假丝酵母菌及肺炎克雷伯菌,分别占16.33%、13.82%及10.80%;病原体均具有多药耐药性,大肠埃希菌对庆大霉素、左氧氟沙星等具有较高的耐药性,耐药率>80.00%;真菌对两性霉素B、氟胞嘧啶的耐药性高达100.00%,对唑类抗真菌药物的耐药性热带假丝酵母菌明显高于白色假丝酵母菌。结论脑卒中患者医院感染主要以革兰阴性菌、真菌以及革兰阳性菌为主,且为多药耐药菌,是导致死亡重要原因。

OBJECTIVE To investigate the etiology of nosocomial infection in patients mieh sthke and drug resistance and provide the basis information for clinical prevention of nosocomial infections and their treatment. METHODS 3 941 cases of stroke patients admitted to our hospital, 398 of all these cases got hospital infection. Their etiology and drug resistance were analyzed. RESULTS In the sensitivity analysis, we found that E. coli had lower resistance rate to nitrofurantoin, imipenem , and had higher resistance rate to gentamicin, ampicillin, ceftazidime; in the flora resistance survey, we found that hospital infection bacteria fungi was higher than that of other diseases hospital-acquired infections in patients with stroke（P〈0. 05）. amphotericin B, 5-fluorocytosine resistance up to 100% in Fury may be associated with clinical drug habits and geographical distribution fungal resistance; azole resistance in Candida tropicalis was significantly higher than thet in Candida albicans（P〈0. 05）, The hospital infection rate of the patients was 10. 1%. The pathogns inchude 212 G-bacteria. fungi. of 98.76 of G＋ cocci. 12 of atypical pathogens. The top three pathogens were Escherichia coli （65.16. 33 %）; Candida tropicalis （55,13.82%）, and Klebsiella neumonia （43,10.80%）. Pathogens shonred multiple drug resistance. CONCLUSION Stroke patients with hospital infections are mainly intected by G- bacteria. fungi and G＋ coccibased and multi-multi-resistant bacteria, which anud be an important reason of death.