神经内科卒中相关性肺炎的病原菌分布及耐药性分析

Analysis of distribution and drug resistant of pathogens in patients with stokeassociated pneumonia in neurology department

目的:分析神经内科ICU脑卒中相关性肺炎(SAP)患者的病原菌分布情况及耐药特点,为临床合理应用抗感染药物提供参考依据。方法:选取收治的225例神经内科ICU脑卒中相关性肺炎患者的痰培养结果进行回顾性分析,分析其病原菌分布及耐药情况。结果:115例痰培养结果阳性,共分离出198株致病菌,其中革兰阴性菌137株,占69.2%,革兰阳性菌41株,占20.7%,真菌20株,占10.1%。革兰阴性菌对亚胺培兰、美罗培兰、阿米卡星耐药率最低,对头孢曲松、头孢他啶、头孢吡肟、环丙沙星、庆大霉素等普遍耐药;革兰阳性菌对替加环素、万古霉素、利奈唑胺耐药率最低,大部分100%敏感,对苯唑西林、青霉素、红霉素、环丙沙星耐药率最高,部分耐药率达100%,真菌对常用抗真菌药物普遍高度敏感。结论:神经内科ICU SAP患者以革兰阴性菌为主要致病菌,对常用抗生素耐药现象普遍,部分呈多重耐药,临床医师应尽早多次对患者的痰标本进行细菌培养及药敏试验,根据其病原菌的分布特点及耐药性合理选择抗菌药物进行治疗。

Objective：To analyze the distribution and drug resistance of pathogens in patients with stroke- associated pneumonia （SAP） in neurology department of ICU and to provide a reference for rational use of anti-infective drugs in clinic.Metkods：The sputum culture results of 225 patients with ICU stroke-associated pneumonia admitted in department of neurology were retrospectively analyzed, and the distribution and drug resistance of the pathogens were analyzed.Results：A total of 198 strains of pathogens were isolated from 115 sputum cultures, of which 137 were Gram-negative bacteria, accounting for 69.2%, 41 Gram-positive bacteria, accounting for 20.7% and 20 were fungi, accounting for 10.1%.Cram-negative bacteria showed the lowest resistance rate to imipenem, meropenem and amikaein, and were generally resistant to eeftriaxone, ceftazidime, cefepime, eiprofloxacin and gentamicin; Gram-positive The rates of resistance to tigeeycline, vancomyein and linezolid were the lowest, most of them were 100% sensitive, and the rates of resistance to oxacillin, penicillin, erythromycin and ciprofloxacin were the highest 100%, fungi are generally highly sensitive to commonly used antifungal agents.Conclusions：Neurology ICU SAP patients with Gram-negative bacteria as the main pathogens, common antibiotic resistance is widespread, some were multi-drug resistance, clinicians should be as many as possible on the patient＇s sputum specimens for bacterial culture and drug susceptibility testing, according to The distribution of its pathogens and drug resistance rational choice of antimierobial drugs for treatment.