重症监护病房脑卒中后肺炎患者多药耐药菌感染病原学检测分析

Etiological detection and analysis of multidrug resistant bacteria infection in patients with post-stroke pneumonia in intensive care unit

目的分析重症监护病房(ICU)脑卒中后肺炎患者多药耐药菌感染的病原学分布。方法回顾性分析2014年6月~2018年6月我院ICU收治的190例脑卒中后肺炎患者的临床资料,对其进行多药耐药菌感染病原学分布及耐药性分析。结果190例ICU脑卒中后肺炎患者中,共有110例并发多药耐药菌感染,感染率为57.89%。分离培养出多药耐药菌病原200株,其中革兰阴性菌148株,占74.0%,革兰阳性菌49株,占24.50%,真菌3株,占1.50%。革兰阴性杆菌中,铜绿假单胞菌对氨苄西林、头孢曲松的耐药率较高;肺炎克雷伯菌对庆大霉素的耐药率较高;鲍氏不动杆菌对氨苄西林、氨曲南、头孢曲松的耐药率较高。革兰阳性杆菌中,金黄色葡糖球菌对青霉素、红霉素、环丙沙星、四环素、氨苄西林及庆大霉素的耐药率较高;溶血葡糖球菌对青霉素、红霉素、环丙沙星、氨苄西林及庆大霉素的耐药率较高;表皮葡糖球菌对四环素、红霉素的耐药率较高。结论多药耐药菌所占比例较高,对多重抗生素呈广泛的不同程度的耐药,临床上应科学选择耐药率抗菌药物进行治疗。

Objective To analyze the pathogenic distribution of multidrug resistant bacterial infections in patients with post-stroke pneumonia in intensive care unit(ICU).Methods The clinical data of 190 patients with post-stroke pneumonia admitted to ICU of our hospital from June 2014 to June 2018 were were retrospectively analyzed.The pathogenic distribution and drug resistance of multi-drug resistant bacterial infections were analyzed.Results Among 190 ICU patients with post-stroke pneumonia,a total of 110 patients with post-stroke pneumonia in ICU were infected with multidrug-resistant bacteria,the infection rate was 57.89%.Two hundred strains of multidrug-resistant bacteria were isolated and cultured,including 148 strains of gram-negative bacteria,accounted for 74.0%,49 strains of gram-positive bacteria,accounted for 24.50%,and 3 strains of fungi,accounted for 1.50%.Among gram-negative bacilli,the resistence rate of pseudomonas aeruginosa was higher to Ampicillin and Ceftriaxone;the resistence rate of klebsiella pneumoniae was higher to Gentamicin,and the resistence rate of acinetobacter bauxii was higher to Ampicillin,Amtraline and Ceftriaxone.Among gram-positive bacteria,the resistence rate of staphylococcus aureus aureus were higher to Penicillin,Erythromycin,Ciprofloxacin,Tetracycline,Ampicillin and Gentamicin,the resistence rate of hemolytic glucococcus was higher to Penicillin,Erythromycin,Ciprofloxacin,Ampicillin and Gentamicin,and the resistence rate of glucococcus epidermidis was higher to Tetracycline and Erythromycin.Conclusion Multidrug-resistant bacteria account for a high proportion and are widely resistant to multiple antibiotics in varying degrees.Sensitive antibiotics should be scientifically selected for clinical treatment.