高血压脑出血患者术后下呼吸道感染的病原菌分布特征分析

Distribution of pathogens causing postoperative lower respiratory tract infections in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血术后患者下呼吸道感染的临床病原菌分布特征,为有效防治高血压脑出血术后患者下呼吸道感染提供理论指导与依据。方法回顾性分析2014年1月-2015年4月90例发生下呼吸道感染的高血压脑出血术后患者的临床资料和痰培养及药敏试验结果进行分析。结果高血压脑出血术后90例下呼吸道感染患者共分离出病原菌103株,其中革兰阴性菌65株占63.1%,以鲍氏不动杆菌、肺炎克雷伯菌和铜绿假单胞菌为主,革兰阳性菌36株占35.0%,以金黄色葡萄球菌和表皮葡萄球菌为主,真菌2株占1.9%,全部为白色假丝酵母菌;鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对亚胺培南、头孢哌酮/舒巴坦敏感;金黄色葡萄球菌及表皮葡萄球菌对万古霉素、磺胺甲噁唑/甲氧苄啶敏感。结论高血压脑出血术后下呼吸道感染患者的病原菌耐药率较高,临床应以预防为主,合理应用抗菌药物以降低感染率和耐药率。

OBJECTIVE To explore the distribution of pathogens causing postoperative lower respiratory tract infections in patients with hypertensive intracerebral hemorrhage so as to provide theoretical basis for effective prevention and treatment of the postoperative lower respiratory tract infections in the hypertensive intracerebral hemorrhage patients.METHODS The clinical data of 90 hypertensive intracerebral hemorrhage patients complicated with postoperative lower respiratory tract infections who were treated in hospitals from Jan 2014 to Apr 2015 were retrospectively analyzed,and the results of sputum culture and drug susceptibility testing were observed.RESULTS A total of 103 strains of pathogens were isolated from the 90 hypertensive intracerebral hemorrhage patients complicated with postoperative lower respiratory tract infections,including 65（63.1%）strains of gram-negative bacteria,36（35.0%）strains of gram-positive bacteria,and 2（1.9%）strains of fungi.The Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa were dominant among the gram-negative bacteria;the Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria;all of the fungi were Candida albicans.The A.baumannii,P.aeruginosa,and K.pneumoniae were susceptible to imipenem and cefoperazone-sulbactam;the S.aureus and S.epidermidis were susceptible to vancomycin and sulfamethoxazole-trimethoprim.CONCLUSIONThe drug resistance rates of the pathogens isolated from the hypertensive intracerebral hemorrhage patients complicated with postoperative lower respiratory tract infections are relatively high.It is necessary for the hospital to focus on the prevention and reasonably use antibiotics so as to reduce the infection rate as well as the drug resistance rate.