急性脑卒中患者肺部感染的病原菌特点与耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in patients with acute stroke

目的探讨急性脑卒中患者肺部感染的病原菌特点及其对抗菌药物的耐药性,为临床早期控制急性脑卒患者肺部感染提供参考依据。方法回顾性分析医院2013年1月-2015年2月收治的254例急性脑卒中患者的临床资料,分析患者肺部感染率、痰液培养后病原菌分布特点及耐药性;采用SPSS17.0软件对数据进行统计分析。结果 254例急性脑卒中患者发生肺部感染56例,发生率为22.05%;共分离出病原菌69株,其中革兰阴性菌53例占76.81%,革兰阳性菌13株占18.84%,真菌3株占4.35%;革兰阴性菌中肺炎克雷伯菌对头孢吡肟和环丙沙星的耐药性较高,分别达76.47%和82.35%;鲍氏不动杆菌对环丙沙星和哌拉西林的耐药性达61.54%和53.85%;铜绿假单胞菌对环丙沙星和哌拉西林的耐药率为66.67%和55.56%;革兰阳性菌中金黄色葡萄球菌对青霉素G、头孢唑林、甲氧嘧啶及左氧氟沙星的耐药率较高,>80.00%;肺炎链球菌对青霉素G、头孢唑林、克林霉素、甲氧嘧啶和左氧氟沙星的耐药率>50.00%。结论急性脑卒中患者肺部感染的病原菌主要以革兰阴性菌为主,临床医师应根据病原菌培养鉴定及药敏试验结果科学合理地应用抗菌药物。

OBJECTIVE To explore the distribution and drug resistance of the pathogens causing pulmonary infections in the patients with acute stroke so as to provide guidance for early clinical control of pulmonary infections in the acute stroke patients.METHODS The clinical data of 254 acute stroke patients who were treated in the hospital from Jan 2013 to Feb 2015 were retrospectively analyzed,the incidence of pulmonary infections,distribution and drug resistance of the pathogens cultured from sputum specimens were observed,and the statistical analysis of data was performed with the use of SPSS17.0software.RESULTS Of 254 acute stroke patients,56 had pulmonary infections with the incidence rate of 22.05%.A total of 69 strains of pathogens were isolated,including53（76.81%）strains of gram-negative bacteria,13（18.84%）strains of gram-positive bacteria,and 3（4.35%）strains of fungi.Among the gram-negative bacteria,the drug resistance rates of the Klebsiella pneumoniae to cefepime and ciprofloxacin were 76.47% and 82.35%,respectively;the drug resistance rates of the Acinetobacter baumannii to ciprofloxacin and piperacillin were 61.54% and 53.85%,respectively;the drug resistance rates of the Pseudomonas aeruginosa to ciprofloxacin and piperacillin were 66.67% and 55.56%,respectively.Among the gram-negative bacteria,the drug resistance rates of the Staphylococcus aureus to penicillin G,cefazolin,trimethoprim,and levofloxacin were more than 80.00%;the drug resistance rates of the Streptococcus pneumoniae to penicillin G,cefazolin,clindamycin,trimethoprim,and levofloxacin were more than 50.00%.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing pulmonary infections in the patients with acute stroke.It is necessary for the clinicians to reasonably use antibiotics based on the results of culture of pathogens and drug susceptibility testing.