脑卒中相关性肺炎患者病原体分析

Analysis on pathogens in 310 patients with stroke- associated pneumonia

目的探讨卒中相关性肺炎患者的病原学特点及药物敏感性,为临床合理使用抗菌药物及经验性抗感染治疗提供参考依据。方法回顾性分析310例急性期脑卒中相关性肺炎患者相关临床资料(一般情况、痰培养及药物敏感试验结果),计算病原菌检出率、分析药物敏感试验结果。结果痰培养细菌检出321株,检出率为74.3%。病原菌以G-菌为主(72.9%),其次为G+菌(15.3%)和真菌(11.8%)。G-菌中以肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌为主,G+菌中以金黄色葡萄球菌为主,真菌以白色念珠菌为主。药敏试验结果显示G-菌对阿米卡星、亚胺培南、哌拉西林/他唑巴坦较敏感,G+菌对万古霉素、替考拉宁和利奈唑烷较敏感,真菌对氟康唑、伊曲康唑、伏立康唑、5-氟胞嘧啶较敏感。结论脑卒中相关性肺炎的致病菌以G-菌为主,应根据患者的痰培养病原学特点合理使用抗菌药物,增加SAP患者的治愈率。

Objective To study the pathogenicity characters and drug sensitivity in patients with stroke -associated pneumonia to provide basis for rational drug use and empirical anti - infective therapy in the clinic. Methods The clinical data, including general situation, results of sputum culture and drug sensitivity tests, of 310 acute stroke patients with SAP in our hospital were retrospectively an- alyzed. The pathogen detection rate were calculated, and the drug sensitivity tests were analyzed. Results A total of 321 strains were iso- lated in the phlegm bacterial cultures, and the positive rate was 74.3%. The pathogens showed that 72.9% were gram negative （ G- ） bacteria, and that 15.3 % were gram positive （G ＋ ） bacteria, and that 11.8% were fungi. Gram negative （G-） bacteria mainly included klebsiella pneumonia, acinetobacter baumanii and pseudomonas aeruginosa. Gram positive （G ＋ ） bacteria mainly included staphylococcus aureus. Fungi mainly included candida albicans. The most gram negative （ G- ） bacteria were highly susceptible to amikacin, imipenem, piperacillin/tazobactam. Gram positive （ G ＋ ） bacteria were highly susceptible to teicoplanin, vancomycin and linezolid. Fungi were highly susceptible to fluconazol, itraconazole, voriconazole and 5 - Flucytcin. Conclusion The major pathogenic bacteria causing SAP are Gram negative bacteria. According to their pathogenic characteristics, we should use antimicrobial drugs rationally to increase the cure rate of SAP.