老年脑卒中住院患者院内感染的病原学特点及治疗

Etiological Characteristics and Treatment of Nosocomial Infection in Hospitalized Patients with Senile Stroke

目的探讨老年脑卒中住院患者院内感染的病原学特点及其对治疗的指导意义。方法统计180例老年脑卒中患者院内感染发生情况,取出现感染患者感染部位分泌物进行病原微生物培养和药敏实验,分析老年脑卒中住院患者院内感染的病原学特点及其对临床治疗的指导意义。结果 180例老年脑卒中住院患者院内感染发生率为19.44%。35例老年脑卒中住院患者合并院内感染患者共分离出42株病原菌,其中铜绿假单胞菌的比例最高(50.00%),其次为金黄色葡萄球菌(16.67%),再次为大肠埃希菌(9.52%),部分患者亦出现肺炎克雷伯菌等其他细菌感染。其中金黄色葡萄球菌等革兰阳性菌对青霉素、庆大霉素、红霉素、复方新诺明等耐药率较高,对万古霉素和替考拉宁等敏感,而铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌等革兰氏阴性菌对氨苄西林、青霉素、头孢噻吩、庆大霉素、哌拉西林、环丙沙星等的耐药率亦较高,对头孢哌酮、头孢克肟、万古霉素和替考拉宁等敏感。结论老年脑卒中住院患者院内感染主要的病原菌为铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌等,革兰阳性菌对青霉素、庆大霉素、红霉素、复方新诺明等耐药率较高,革兰氏阴性菌对氨苄西林、青霉素、头孢噻吩、庆大霉素、哌拉西林、环丙沙星等的耐药率亦较高,且病原菌均对万古霉素和替考拉宁敏感,早期检出老年脑卒中住院患者院内感染患者的病原菌及其耐药性并选择合理抗菌药物进行治疗有助于其疗效的提高。

Objective To investigate the etiological characteristics of nosocomial infection in elderlyhospitalized patients with stroke and its guiding significance to treatment.Methods The incidence of nosocomial infection in 180 elderly patients with stroke was measured.The pathogen microbiological cultureof the patient＇s secretions and susceptibility test were used to detect the pathogens of nosocomial infection in elderly patients with stroke and the significance of clinical treatment.Results The incidence of nosocomial infection was 19. 44% in 180 elderly patients with stroke.A total of 42 pathogens were isolated from 35 elderly hospitalized patients with stroke.The proportion of Pseudomonas aeruginosa was the highest（ 50. 00%）,followed by Staphylococcus aureus（ 16. 67%）,followed by Escherichia coli（ 9. 52%）,some patients also had Klebsiella pneumoniae and other bacterial infections.Staphylococcus aureus and other Gram-positive bacteria had high resistance rate to penicillin,gentamicin,erythromycin and cotrimoxazole butwere sensitive to vancomycin and teicoplanin. Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae and other Gram-negative bacteria also had high resistance rate to ampicillin,penicillin,cefotaxime,gentamicin,piperacillin,ciprofloxacin,but were sensitive to cefoperazone,cefixime,vancomycin and teicoplanin.Conclusion The main pathogens of nosocomial infection in elderly patients with stroke were Pseudomonas aeruginosa,Staphylococcus aureus,Escherichia coli and Klebsiella pneumoniae as so on.Gram-positive bacteria were resistant to penicillin,gentamicin,erythromycin and cotrimoxazole.Gram-negative bacteria had high resistance rate to ampicillin,penicillin,cefotaxime,gentamicin,piperacillin,ciprofloxacin.Pathogens were all sensitive to vancomycin and teicoplanin.Early detection of pathogens and drug resistance in elderly patients with stroke in hospital infection and selectionof a reasonable antibiotic treatment for treatment are helpful to improve its efficacy.