重症脑卒中患者继发医院获得性肺炎的病原学分析

Pathogens Analysis of Hospital-acquired Pneumonia in Patients with Severe Stroke

目的分析该院重症脑卒中患者继发医院获得性肺炎的病原菌分布特点及耐药情况。方法整群选取该院2012年1月—2014年10月收治的178例重症脑卒中继发医院获得性肺炎患者,对其痰培养及药敏试验结果进行回顾性分析。结果178例肺部感染患者痰培养阳性143例,阳性率80.3%,病原菌共230株。其中革兰氏阴性菌159例,占69.13%;革兰氏阳性菌53例,占23.04%;真菌18例,占7.83%。革兰氏阳性菌对万古霉素、替考拉宁全部敏感。革兰氏阴性菌对头孢吡肟、亚胺培南、阿米卡星、哌拉西林/他唑巴坦及头孢哌酮/舒巴坦均较敏感。结论重症脑卒中合并肺部感染患者以革兰氏阴性菌为主,且存在多重耐药性,及时行痰培养及药敏试验,依据结果合理选择抗生素,避免、控制耐药菌医院感染的发生。

Objective To analyze the distribution and drug resistance of pathogenic bacteria causing hospital- acquired pneumonia（HAP） in severe stroke patients.Methods The results of pecimen culture and drug resistance test of 178 severe stroke patients with hospital- acquired pneumonia admitted to our hospital from January 2012 to Octomber 2014 were retrospectively analyzed.Results Of 178 of HAP positive sputum culture 143 cases,sputum specimen culture positive rate was 80.3%.Of total 230 strains of pathogens isolated from sputum specimen,there were 159（69.13%）strains of gram-negative bacteria,53（23.04%） strains of grampositive bacteria,and 18（7.83%） strains of fungi.Gram-positive bacteria was sensitive to vancomycin andteiooplanin.Gram-negative bacteria were sensitive to cefepime,imipenem,amikacin,piperacillin / tazobactam and cefoperazone / sulbactam.Conclusion Gram —negative bacteria is predominant in severe stroke patients with HAP.Drug resistance is very serious,and the antibiotics should be selected in clinic according to the result of drug susceptibility test.It is necessary for the medical staff to take comprehensive interventions so as to prevent and control the Hospital— acquired pneumonia.