急性脑卒中相关性肺炎的病原菌分布及耐药性分析

Pathogens distribution and drug resistance analysis in patients with stroke-associated pneumonia

目的了解我院急性脑卒中相关性肺炎（SAP）的病原菌分布及耐药性,以指导临床合理应用抗生素。方法对2011年1月~2014年4月我院收治的308例SAP患者中痰标本培养阳性的44例进行回顾性研究,对病原菌的构成及耐药性进行分析。结果 SAP患者共检出细菌11种,真菌4种,病原菌50株。其中革兰阴性杆菌占68.0%,主要为肺炎克雷伯菌、铜绿假单胞菌等;革兰阳性菌占20.0%,以金黄色葡萄球菌为主;真菌占12.0%,主要为白色假丝酵母菌。致病菌对常用抗菌药物产生不同程度的耐药性。铜绿假单胞菌、鲍曼不动杆菌对碳青霉烯类耐药率分别是45%和66.67%。肺炎克雷伯菌、大肠埃希菌对碳青霉烯类未发现耐药。金黄色葡萄球菌中发现MRSA 6株,未发现对利奈唑胺、万古霉素、替加环素耐药的菌株。结论我院SAP的致病菌主要为革兰阴性菌且具有很强的耐药性,临床上应严格掌握适应证,合理应用抗生素,防止多重耐药甚至泛耐药菌的出现及院内传播。

Objective To investigate the pathogen distribution and drug resistance of acute stroke patients with stroke-associated pneumonia（SAP）in department of neurology.Methods 44 patients w in department of neurology ith positive sputum culture specimens in 308 acute stroke patients with SAP were retrospectively studied.The composition of pathogens and drug susceptibility test results were analyzed.Results Sputum and susceptibility test results showed that11 kinds of bacteria and 4kinds of fungi.50 pathogens were detected.Most of them were gram-negative bacterium（68%）,which mainly were Klebsiella pneumoniae,Pseudomonas aeruginosa.Gram-positive bacteria accounted for 20.0%,whihc mainly was Staphylococcus aureus.Fungi accounted for 12.0%,which mainly was White candida.Pathogens to commonly used antimicrobial agents produced varying degrees of drug resistance.The drug resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenem antibiotics was nearly 45% and 66.67%,respectively.While Pneumonia klebsiella and Escherichia coli were 100% sensitive to carbapenes antibiotics.6 MRSA were found.Staphylococcus aureus were 100%sensitive to Linezolid,Vancomycin and Tigecycline.Conclusion The main pathogenic bacteria of SAP patients in department of neurology is gram-negative bacteria and has a strong drug resistance.The clinical indications for antimicrobial drugs should be strictly controlled and should use antibiotics rationally to prevent multidrug resistant and even pan-resistant bacteria selecting and nosocomical transmission.