卒中相关性医院获得性肺炎病原菌调查及耐药性分析

Investigation of pathogen and drug resistance in patients with stroke-associated hospital acquired pneumonia

目的调查和分析卒中相关性医院获得性肺炎的病原菌种类、分离率及其对常见抗菌药物耐药情况,为临床经验性诊疗提供参考。方法收集宁波市第一医院2011年1月—2013年12月卒中相关性医院获得性肺炎病例209例为研究组,收集同期非卒中相关性医院获得性肺炎病例200例设为对照组,比较分析病原菌种类及其耐药性。计数数据以例数、百分率表示,采用χ2检验,检验水准α=0.05。结果研究组病原菌阳性率为64.59%(135/209),共分离出18种病原菌。研究组检出革兰氏阴性菌111株,占82.22%(111/135),比例高于对照组,差异有统计学意义(χ2=10.8333,P=0.001)。研究组革兰氏阴性菌以肠杆科细菌为首位,对含有超广谱β内酰胺酶抑制剂的复合抗菌药物有80%以上的敏感率;非发酵菌占次位,对头孢哌酮舒巴坦保持60%左右敏感性。研究组革兰氏阳性菌以金黄色葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球54.5%。2组肠杆科细菌产ESBLs阳性率比较差异无统计学意义(χ2=0.261,P=0.609),MRSA阳性率比较差异无统计学意义(χ2=0.094,P=0.760)。结论卒中相关性医院获得性肺炎病原菌种类较多,以肠杆科细菌为首位,非发酵菌为次位。耐药相对严重,含有超广谱β内酰胺酶抑制剂的复合抗菌药物可作为初始经验性治疗的首选药物。

Objective To investigate and analyze the pathogen species and their separation rate and drug resistance to common antibiotics in patients with stroke-associated hospital acquired pneumonia, and provide reference for empirical clinical diagnosis and treatment. Methods A total of 209 patients with stroke correlated hospital acquired pneumonia in our hospital were collected from January 2011 to December 2013, and 200 cases of hospital acquired pneumonia without stroke in the same period were collected as control group. The pathogen species and drug resistance were studied. The count data expressed as the number of cases or a percentage, data analysis was carried out by using the χ2 test, test level α = 0.05. Results The positive rate of pathogenic bacteria was 64.59% （135/209） in the researchgroup, and a total of 18 species of pathogenic bacteria was isolated. Among them 111 strains were gram-negative bacteria（ 111/135 ） , the ratio was higher than that in the control group and the difference was statistically significant（ X2 = 10.8333 ,P = 0.001 ）. Enterobacteriaceae bacteria ranked the first in gram-negative bacteria detected in the research group, more than 80% of which were sensitive to antibiotics containing extended-spectrum beta-lactamase inhibitor; the non-fermentative bacteria accounted for second, sensitive rate of which to Cefperazone-Sulbactam was maintained about 60%. Staphylococcus aureus ranked the first in gram-positive bacteria, among which methieiUin-resistant staphylococcus aureus （MRSA） accounted for 54.5%. The positive rate of ESBLs- producing enterobacteriaceae bacteria between two groups had no statistically significant difference（χ2 = 0.261 ,P = 0. 609 ） and the positive rate of MRSA between the two groups also had no statistically significant difference（ χ2 = 0.094,P = 0.760） ） Conclusion There are many pathogen species in stroke-related hospital- acquired pneumonia, among which Enterobacteriaeeae baeteria ranks first and non-fermentative bacteria rank second. The situation of drug resistance is rather serious, so that antibiotics containing extended-spectrum beta-lactamase inhibitor should be given priority to in empiric therapy.