三级康复医院药学会诊脑卒中合并院内感染患者病原菌分布及其耐药情况分析

Distribution and Drug Resistance of Pathogenic Bacteria in Patients with Stroke Complicated with Hospital Infection in Pharmaceutical Consultation in Tertiary Rehabilitation Hospital

背景脑卒中患者免疫力低下,易出现医院获得性感染,且在临床中若抗菌药物使用不当会导致病原菌出现耐药性,而有效预防脑卒中患者发生医院获得性感染可提高其治疗效果并改善预后,因此分析脑卒中合并院内感染患者病原菌分布及其耐药情况尤为重要。目的分析三级康复医院药学会诊的脑卒中合并院内感染患者的病原菌分布及其耐药情况,以期为临床实践提供依据。方法选取2017—2018年首都医科大学附属北京康复医院收治的药学会诊的脑卒中合并院内感染患者198例为研究对象。收集患者临床样本,包括痰液、脓液、穿刺液、血液、分泌物、尿液等,记录其病原菌构成及其耐药情况。结果所有临床样本中,痰液占比最高,为63.1%(125/198)。共检出198株病原菌,其中革兰阴性菌占比最高,为66.7%(132/198),革兰阳性菌占比次之,为26.3%(52/198),真菌占比最低,为7.1%(14/198)。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌对氨苄西林、头孢唑林的耐药率均≥80.0%,对多黏菌素B的耐药率为0~8.3%。粪肠球菌、金黄色葡萄球菌、表皮葡萄球菌对青霉素G的耐药率均≥80.0%,对万古霉素、利奈唑胺均不耐药。热带假丝酵母菌、白色假丝酵母菌对伊曲康唑、伏立康唑、氟康唑的耐药率均>60.0%,而对两性霉素B、5-氟胞嘧啶均不耐药。结论三级康复医院药学会诊的脑卒中合并院内感染患者病原菌以革兰阴性菌为主。对于革兰阴性菌感染患者,药敏试验前可经验性给予多黏菌素B治疗;对于革兰阳性菌感染患者,药敏试验前可经验性给予万古霉素、利奈唑胺治疗;对于真菌感染患者,药敏试验前可经验性给予两性霉素B、5-氟胞嘧啶治疗。

Background Stroke patients have weak immunity and are prone to hospital-acquired infections,and improper using of antibiotics in clinic can lead to drug resistance of pathogens.However,effective prevention of hospitalacquired infections in stroke patients can improve the treatment effect and prognosis,so it is particularly important to analyze the types of pathogenic bacteria and their drug resistance in patients with stroke complicated with hospital infection.Objective To analyze the distribution and drug resistance of pathogenic bacteria in patients with stroke complicated with hospital infection in pharmacy consultation in tertiary rehabilitation hospital,in order to provide a basis for clinical practice.Methods A total of 198 patients with stroke complicated with hospital infection in pharmaceutical consultation who were admitted to Beijing Rehabilitation Hospital,Capital Medical University from 2017 to 2018 were selected as the research objects.The clinical samples of patients,including sputum,pus,puncture fluid,blood,secretions,urine,etc.were collected,and the composition of pathogenic bacteria and their drug resistance were recorded.Results Among all clinical samples,sputum accounted for the highest proportion at 63.1%(125/198).A total of 198 strains of pathogens were detected,among which Gram-negative bacteria accounted for the highest proportion at 66.7%(132/198),followed by Gram-positive bacteria at 26.3%(52/198),and fungi accounted for the lowest proportion at 7.1%(14/198).The resistance rates of Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,and Pseudomonas aeruginosa to ampicillin and cefazolin were all≥80.0%,the resistance rates to polymyxin B were 0-8.3%.The resistance rates of Enterococcus faecalis,Staphylococcus aureus,and Staphylococcus epidermidis to penicillin G were all≥80.0%,but they were not resistant to vancomycin and linezolid.The resistance rates of Candida tropicalis and Candida albicans to itraconazole,voriconazole,and fluconazole were all>60.0%,but they were not resistant to amphotericin B and 5-fluorocytosine.Conclusion Gram-negative bacteria are the main pathogens in the pharmacy consultation of tertiary rehabilitation hospitals for stroke patients complicated with hospital infection.Before the drug sensitivity test,for patients with Gram-negative bacteria infection,polymyxin B can be given empirically;for patients with Gram-positive bacteria infection,vancomycin and linezolid can be given empirically;and for patients with fungi infection,amphotericin B and 5-fluorocytosine can be given empirically.