老年卒中合并肺部感染患者的病原菌分布和耐药性及预防策略分析

Pathogen distribution,drug resistance and preventive strategies in elderly stroke patients with pulmonary infection

目的探讨老年卒中合并肺部感染患者的病原菌分布和耐药性,分析其预防策略。方法我院2014年6月至2017年6月305例老年脑卒中患者,连续采集3 d患者痰液标本,进行菌种鉴定分型与药敏试验分析。结果 305例患者发生肺部感染58例,共分离出96株病原菌,包括革兰阴性菌70株、革兰阳性菌18株、真菌8株,其中前五位菌种依次为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、大肠埃希菌。肺炎克雷伯菌对头孢哌酮/舒巴坦、哌拉西林、阿米卡星、阿米卡星、环丙沙星、亚胺培南、美罗培南、氨苄西林/舒巴坦等抗生素较敏感;铜绿假单胞菌对头孢哌酮/舒巴坦、环丙沙星、亚胺培南、氨苄西林/舒巴坦等抗生素较敏感;鲍氏不动杆菌对阿米卡星、亚胺培南、美罗培南等抗生素较敏感,耐药率均≤20%。金黄色葡萄球菌对呋喃妥因、万古霉素、利奈唑胺敏感,肺炎链球菌对呋喃妥因与万古霉素敏感,表皮葡萄球菌对万古霉素敏感,耐药率均为0。结论老年卒中合并肺部感染患者主要病原体为革兰阴性菌,其次为革兰阳性菌、真菌。肺部感染病原菌多呈多重耐药,可根据药敏结果指导临床抗菌治疗,避免耐药菌产生。

To investigate the distribution and drug resistance of pathogens in elderly stroke patients with pulmonary infection,and analyze the prevention strategies.We continuously collected sputum samples for 3 days from 305 elderly stroke patients in our hospital during the period from June 2014 to June 2017 to perform strain identification,typing and drug sensitivity test.There were 58 cases with pulmonary infection in the 305 elderly stroke patients.A total of 96 strains of pathogens were isolated,including 70 strains of gram-negative bacteria,18 strains of gram-positive bacteria and 8 strains of fungi.The top five strains were Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus and Escherichia coli.Klebsiella pneumoniae was sensitive to antibiotics such as cefoperazone/sulbactam,piperacillin,amikacin,ciprofloxacin,imipenem,meropenem and ampicillin/sulbactam.Pseudomonas aeruginosa was sensitive to antibiotics such as cefoperazone/sulbactam,ciprofloxacin,imipenem and ampicillin/sulbactam.Acinetobacter baumannii was more sensitive to antibiotics such as amikacin,imipenem and meropenem.All drug resistance rates were≤20%.Staphylococcus aureus was sensitive to furantoin,vancomycin and linezolid.Streptococcus pneumoniae was sensitive to furontoin and vancomycin,and Staphylococcus epidermidis was sensitive to vancomycin and the drug resistance rate was 0.0%.The main pathogens of elderly stroke patients with pulmonary infection are gram-negative bacteria followed by gram-positive bacteria and fungi.The pathogens of pulmonary infection are multi-drug resistant.Therefore,the clinical antibacterial treatment can be carried out according to the results of drug sensitivity test to avoid the production of drug-resistant bacteria.