急诊监护病房卒中相关性肺炎病原体的分布和耐药性分析

Analysis of the distribution and drug resistance of pathogenic bacteria of stroke associated pneumoniain emergency intensive care unit

目的分析急诊监护病房(EICU)卒中相关性肺炎(SAP)病原体的分布和耐药性情况。方法选择2015年1月至2015年12月本院EICU收治的52例SAP患者,对其痰培养及药敏试验结果进行回顾性分析。结果 52例SAP患者痰培养阳性44例,阳性率为84.6%,发生多重耐药菌(MDR)感染者26例,发生率为59.1%。共分离出病原菌68株,其中多重耐药菌54株,包括革兰阴性杆菌37株,革兰阳性球菌14株,真菌3例。分离获得的多重耐药菌中前五位依次为:鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、溶血性葡萄球菌。革兰阴性菌对阿米卡星和哌拉西林/三唑巴坦较敏感。结论 EICU中的SAP患者以革兰阴性菌感染为主,且存在多重耐药;及时行痰培养及药敏试验,依据药敏结果合理选择抗生素,同时严格遵守无菌技术操作规程,尽量减少有创操作,有助于控制MDR的发生。

Objective To analyze the distribution and drug resistance of pathogenic bacteria of stroke associated pneumonia （SAP） in emergency intensive care unit （EICU）. Method 52 cases of SAP admitted to hospital from January 2013 to December 2015 were enrolled in the study, and then the sputum culture and drug susceptibility test results were retrospectively analyzed. Result sputum culture is positive for 44 patients with SAP in 52 cases, the positive rate was 84.6%, and 26 cases were multiple drug-resistant bacteria （MDR） infected, the incidence was 59.1%. A total of 68 strains pathogenic bacteria were isolated including 54 MDR, in which there were 37 strains of gram-negative bacilli, 14 strains of gram-positive cocci and 3 cases fungi. The first 5 strains were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Hemolytic staphylococcus. Gram-negative bacilli were sensitive.to amikacin and piperacillin/triazole. Conclusion The major pathogenic bacteria causing SAP in EICU were gram-negative bacilli and MDR were common, therefore sputum culture and drug sensitive test should be done in time. According to their pathogenic characteristics, we should use antibiotics rationally, strict aseptic technique procedures and minimize the invasive operation to control the occurrence of MDR.