呼吸科病房卒中相关性肺炎病原体的分布及耐药性分析

Distribution and antibiotic resistance of pathogens isolated from patients with stroke-associated pneumonia in Department of Respiratory Medicine

目的分析呼吸科病房卒中相关性肺炎(SAP)患者的病原菌分布特点及对抗菌药物的耐药情况,以指导临床用药。方法选取2007年1月—2014年1月入住呼吸科的SAP患者,分离培养病原菌,对其药敏结果进行回顾性分析。调查其中多重耐药菌的分离率。比较脑出血及脑梗死合并肺炎病原菌分布差别。结果 325例SAP患者中,细菌分离阳性患者40例,占12.3%,共分离到50株细菌,以革兰阴性杆菌为主,46株(92.0%),主要菌种依次为铜绿假单胞菌15株(30.0%)、大肠埃希菌11株(22.0%)、鲍曼不动杆菌5株(10.0%)和沙雷菌5株(10.0%)等。革兰阳性球菌均为金黄色葡萄球菌(金葡菌)4株(8.0%),且为耐甲氧西林金葡菌(MRSA)。铜绿假单胞菌对亚胺培南及氨基糖苷类抗生素均呈现敏感,对第三代头孢菌素耐药率高。大肠埃希菌对亚胺培南、哌拉西林-他唑巴坦均敏感。鲍曼不动杆菌均为多重耐药菌,对亚胺培南、氨基糖苷类抗生素及第四代头孢菌素耐药率≥40%。4株MRSA对万古霉素、利奈唑胺均敏感。在分离的50株细菌中,多重耐药菌38株,约占76.0%。脑出血及脑梗死合并肺炎在大肠埃希菌分离上差异有统计学意义(P<0.01)。结论呼吸科病房SAP患者的主要病原菌为革兰阴性杆菌,以不发酵糖革兰阴性杆菌和肠杆菌科为主,大部分呈多重耐药性。MRSA亦为重要的病原菌,不容忽视。脑出血及脑梗死合并肺炎病原菌分布除大肠埃希菌外差异无统计学意义。因此应加强监测SAP患者病原菌的构成及耐药性,为临床用药提供参考,提高救治率。

Objective To analyze the distribution ,antibiotic resistance of the pathogens isolated from patients with stroke‐associated pneumonia （SAP） in Department of Respiratory Medicine for better clinical medication .Methods The SAP patients who were treated in the hospital from January 2007 to January 2014 were included in this study .The pathogens were cultured and isolated .Antimicrobial susceptibility of these pathogens was analyzed retrospectively .The multidrug resistant bacteria were identified .Pathogen distribution was compared between the pneumonia associated with cerebral hemorrhage and that associated with cerebral infarction .Results A total of 50 strains of bacterial pathogens were isolated from 40 （12 .3% ） of all the 325 SAP patients ,including 46 strains of gram negative bacilli （92 .0% ） （mainly P . aeruginosa ,15 ;E . coli ,11 ;A . baumannii ,5 ;and S .marcescens ,5） and 4 （8 .0% ） strains of S .aureus ,all resistant to methicillin （MRSA） .P .aeruginosa isolates were not resistant to imipenem or aminoglycoside antibiotic ,but highly resistant to the third generation cephalosporins . E .coli strains were not resistant to imipenem or piperacillin‐tazobactam .A .baumannii strains were all multi‐drug resistant . At least 40% of these strains were resistant to imipenem ,aminoglycosides or the fourth generation cephalosporins .All the 4 were gram negative bacilli in Department of Respiratory Medicine ,mainly non‐fermentative bacteria and Enterobacteriaceae , most of which were multi‐drug resistant .MRSA is becoming an important pathogenic bacteria .The prevalence of E .coli is significantly different between the pneumonia associated with cerebral hemorrhage and that associated with cerebral infarction .