急性卒中相关性肺炎患者痰标本中的病原菌分布与耐药性分析

Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Sputum Specimens of Patients with Acute Stroke-associated Pneumonia

目的:分析急性卒中相关性肺炎(stroke-associated pneumonia,SAP)患者痰标本中的病原菌分布与耐药情况。方法:选取2019年2月—2021年2月河南大学第一附属医院收治的108例急性SAP患者作为研究对象,采集其痰标本进行微生物培养和药敏试验,分析病原菌的分布和药敏特点。结果:108例急性SAP患者中99例的微生物培养结果呈阳性,阳性率为91.67%;患者标本中共检出病原菌116株,其中革兰阴性菌78株(占67.24%,以鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌为主)、革兰阳性菌30株(占25.86%,以金黄色葡萄球菌和粪肠球菌为主)和真菌8株(占6.90%);鲍曼不动杆菌对所有抗菌药物的耐药率均较高(>45.00%),肺炎克雷伯菌和铜绿假单胞菌仅对阿米卡星耐药率较低(<10.00%),铜绿假单胞菌对氨苄西林-舒巴坦钠、哌拉西林-他唑巴坦钠和哌拉西林的耐药率相对较低(15.38%);金黄色葡萄球菌和粪肠球菌对万古霉素和替考拉宁的耐药率均为0.00%。结论:急性SAP患者痰标本中的病原菌以革兰阴性菌为主,其中主要病原菌多重耐药情况突出,临床应依据药敏试验结果合理选用抗菌药物。

Objective: To analyze the distribution and drug resistance of pathogenic bacteria in sputum specimens of patients with acute stroke-associated pneumonia(SAP). Methods: A total of 108 cases of acute SAP patients admitted to the First Affiliated Hospital of Henan University from February 2019 to February 2021 were selected. Sputum samples were collected for microbiological culture and drug susceptible test to analyze the distribution and drug resistance characteristics of pathogenic bacteria. Results: A total of 99 case of 108 patients with acute SAP were positive in microbiological culture, with a positive rate of 91.67%. A total of 116 strains of pathogenic bacteria were detected, including78 Gram-negative strains(67.24%, dominated by Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa), 30 Gram-positive strains(25.86%, dominated by Staphylococcus aureus and Enterococcus faecalis) and 8strains of fungi(6.90%). The drug resistance rates of Acinetobacter baumannii to all antibacterials were high(greater than 45.00%), the drug resistance rates of Klebsiella pneumoniae and Pseudomonas aeruginosa to only amikacin were low(less than 10.00%), and the drug resistance rates of Pseudomonas aeruginosa to ampicillin-sulbactam, piperacillintazobactam and piperacillin were relatively low(all 15.38%). The resistance rates of Staphylococcus aureus and Enterococcus faecalis to vancomycin and teicoplanin were 0.00%. Conclusion: The pathogenic bacteria in sputum samples of acute SAP patients are mainly Gram-negative bacteria, among which the main pathogenic bacteria have prominent multi-drug resistance. Therefore, antibacterial drugs should be rationally selected according to the results of drug sensitivity test in clinical practice.