脑中风患者肺部感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in patients with cerebral apoplexy

目的研究脑中风患者肺部感染的病原菌种类及耐药性,以指导临床合理应用抗菌药物。方法选取脑中风合并肺部感染的患者138例,从患者的痰液中分离培养病原菌,并采用K-B琼脂法对病原菌的耐药性进行分析。结果医院进行诊断并治疗的脑中风患者共3 176例,其中发生肺部感染138例,肺部感染率4.35%;检出革兰阳性菌42株占28.77%,其中金黄色葡萄球菌、表皮葡萄球菌分别占15.76%、13.01%,革兰阴性菌104株占71.23%,肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、变形菌属、大肠埃希菌、鲍氏不动杆菌分别占19.86%、14.38%、10.96%、10.96%、7.53%、2.74%;主要革兰阳性菌对替莫唑胺、乙酰唑胺和替考拉宁的耐药率较低,为0-5.26%,主要革兰阴性菌对美罗培南、阿米卡星和替考拉宁的耐药率较低,为0-4.76%。结论脑中风患者肺部感染的发生率高,临床应采取措施控制脑中风患者发生肺部感染,如患者发生肺部感染,应分离培养病原菌并进行耐药性分析,选择耐药率低的抗菌药物进行治疗。

OBJECTIVE To study the distribution and drug resistance of pathogens causing pulmonary infections in patients with cerebral apoplexy so as to provide guidance for reasonable use of antibiotics.METHODS A total of138cerebral apoplexy patients complicated with pulmonary infections were enrolled in the study,then the pathogens were cultured from sputum specimens obtained from the patients,and the drug resistance of the pathogens was analyzed with the use of K-B agar method.RESULTS Of totally 3 176patients with confirmed cerebral apoplexy who were treated in the hospital,the pulmonary infections occurred in 138cases with the infection rate of4.35%.There were 42（28.77%）strains of gram-positive bacteria,among which the Staphylococcus aureus accounted for 15.76%,the Staphylococcus epidermidis 13.01%;there were 104（71.23%）strains of gram-negative bacteria,among which the Klebsiella pneumoniae accounted for 19.86%,the Enterobacter cloacae 14.38%,the Pseudomonas aeruginosa 10.96%,the Proteus 10.96%,the Escherichia coli 7.53%,the Acinetobacter baumannii 2.74%.The drug resistance rates of the main gram-positive bacteria to temozolomide,acetazolamide,and teicoplanin varied from 0to 5.26%;the drug resistance rates of the main gram-negative bacteria to meropenem,amikacin,and teicoplanin varied from 0to 4.76%.CONCLUSIONThe incidence of pulmonary infections is high in the patients with cerebral apoplexy.It is necessary for the clinician to take measures to control the pulmonary infections in the patients with cerebral apoplexy;once the pulmonary infections occur,the isolation and culture of pathogens should be performed,and the drug resistance is analyzed so as to choose sensitive antibiotics for treatment.