老年患者卒中后下呼吸道感染的病原菌分布及耐药性

Distribution and drug resistance of pathogens causing lower respiratory tract infection in elderly patients after stroke

目的:探讨老年患者卒中后感染下呼吸道的病原菌分布和耐药性。方法:2019年6月-2020年6月收治老年卒中后下呼吸道感染患者143例,取痰液进行细菌培养,以药敏试验检测耐药性。结果:共分离出病原菌157株,其中革兰阳性菌53株(33.76%),以金黄色葡萄球菌为主;革兰阴性菌102株(64.97%)。金黄色葡萄球菌对利奈唑胺、万古霉素和替加环素的敏感性最高(100.00%),对青霉素完全耐药(100.00%);其中耐甲氧西林金黄色葡萄球菌(MRSA)21株,检出率为56.00%。铜绿假单胞菌对阿米卡星的耐药性最低(0%),对环丙沙星的耐药性最高(77.95%)。肺炎克雷伯菌对氨苄西林耐药性最高(100.00%),对阿米卡星、厄他培南、头孢替坦和亚胺培南的敏感性最高(100.00%);其中ESBLs菌株10株,检出率为28.00%。结论:老年卒中患者下呼吸道感染病原菌以革兰阴性菌为主,医护人员应加强临床监护,及时调整药物使用,降低多重耐药菌耐药性。

Objective:To explore the distribution and drug resistance of pathogens causing lower respiratory tract infection in elderly patients after stroke.Methods:From June 2019 to June 2020,143 elderly patients with lower respiratory tract infection after stroke were selected.Sputum was taken for bacterial culture,and drug resistance was detected by drug sensitivity test.Results:A total of 157 strains of pathogens were isolated,of which 53 strains(33.76%)were gram-positive,most of them were Staphylococcus aureus.There were 102 strains(64.97%)of gram negative bacteria.Staphylococcus aureus was most sensitive to linezolid,vancomycin and tigecycline(100.00%),and completely resistant to penicillin(100.00%).Among them,21 strains of methicillin-resistant Staphylococcus aureus(MRSA)were detected,and the detection rate was 56.00%.Pseudomonas aeruginosa had the lowest resistance to amikacin(0%)and the highest resistance to ciprofloxacin(77.95%).Klebsiella pneumoniae had the highest resistance to ampicillin(100.00%),and the highest sensitivity to amikacin,ertapenem,cefotetan and imipenem(100.00%).There were 10 ESBLs strains,and the detection rate was 28.00%.Conclusion:Gram negative bacteria are the main pathogens of lower respiratory tract infection in elderly stroke patients,medical staff should strengthen clinical monitoring,timely adjust the use of drugs,and reduce the drug resistance of multidrug-resistant bacteria.