某三甲医院4年间脑卒中并发肺炎患者感染细菌分布及耐药性分析

Distribution and Drug Resistance of Infectious Bacteria in Patients with Stroke Complicated with Pneumonia in a Tertiary Hospital during 4 Years

目的:基于某医院抗菌药物耐药监测,分析调查脑卒中并发肺炎患者常见病原菌分布特征及抗菌药物使用情况。方法:使用来自广安某三甲医院4年间抗菌药物药敏试验记录进行横断面回顾性研究,对纳入统计的132株细菌药敏结果进行分析。结果:病原菌包括细菌及真菌,其中革兰氏阴性菌占比80.3%,主要为大肠埃希菌及肺炎克雷伯菌,大肠埃希菌和克雷伯菌中产ESBLs株,分别占11.1%和52.5%,革兰阳性菌中以葡萄球菌为主,暂未鉴定出肺炎链球菌。最常用的抗菌药物以头孢噻肟、哌拉西林/他唑巴坦及美罗培南为主,联合用药占比为60.8%,尚未发现耐碳青霉烯大肠埃希菌及肺炎克雷伯菌,未鉴定出铜绿假单胞菌粘菌素耐药株。结论:脑卒中并发肺炎感染病原菌是以大肠埃希菌及肺炎克雷伯菌为主的革兰阴性菌,临床应引起足够重视,规范临床合理使用抗菌药物,加强预防感染措施,减缓细菌耐药,促进患者预后的提高和整体医疗进步。Objective: Based on the monitoring of antimicrobial resistance in a hospital, the distribution characteristics of common pathogenic bacteria and the use of antimicrobial agents in stroke patients complicated with pneumonia were analyzed and investigated. Methods: The results of antimicrobial susceptibility from a hospital in Guang’an in four years were retrospectively studied, and 132 strains of bacteria included in the statistics were analyzed. Results: Pathogens include bacteria and fungi, among which gram-negative bacteria account for 80.3%, mainly E. coli and K. pneumoniae. E. coli and K. pneumoniae produce ESBLs strains, accounting for 11.1% and 52.5% respectively. Staphylococcus is the main Gram-positive bacteria, and S. pneumoniae has not been found yet. The most commonly used antimicrobial agents are cefotaxime, piperacillin/tazobactam and meropenem, and the combined use of antimicrobial agents accounts for 60.8%. No carbapenem-resistant strains of Escherichia coli and Klebsiella pneumoniae have been found, and no colistin-resistant strains of Pseudomonas aeruginosa have been identified. Conclusion: E. coli and K. pneumoniae are the main pathogens of pneumonia infection in stroke patients, so we should pay enough attention to it in clinic, standardize the rational use of antibacterial drugs in clinic, strengthen infection prevention measures, slow down bacterial resistance, and promote the improvement of patients’ prognosis and overall medical progress.