冠心病患者支架植入术后肺部感染病原菌分析  

Analysis of pathogens of pulmonary infection in patients with coronary heart disease after stent implantation

作　　者：王士生[1] 寿成珉[2] 隋向前[1] 刘颖慧[2] 

机构地区：[1]杭州市红十字会医院心内科,浙江杭州310003 [2]杭州市红十字会医院内分泌科,浙江杭州310003

出　　处：《中华医院感染学杂志》2014年第8期1990-1992,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(2008A136)

摘　　要：目的探讨冠心病患者支架植入术后发生肺部感染病原菌及其耐药性,为临床抗菌药的合理应用提供参考。方法选取2010年10月-2013年10月医院行支架植入术冠心病患者240例,对其术后送检的痰液标本进行病原菌分离,并行药敏试验。结果 240份标本共分离出98株病原菌,检出率为40.83%,其中革兰阴性菌46株占46.94%,以铜绿假单胞菌为主,共13株占13.26%,其次为鲍氏不动杆菌,共8株占8.16%;革兰阳性菌28株占28.57%,以金黄色葡萄球菌为主,共9株占9.18%,其次为溶血性葡萄球菌,共8株占9.16%;真菌24株占24.49%,以白色假丝酵母菌为主,共16株占16.33%;革兰阴性菌对于氨曲南、氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢唑林具有较高的耐药性,均>85.00%;革兰阳性菌对克林霉素、左氧氟沙星、红霉素、青霉素有较高的耐药性,多数可达100.00%;白色假丝酵母菌的耐药率普遍较低。结论白色假丝酵母菌、铜绿假单胞菌、葡萄球菌属等为冠心病患者支架植入术后发生肺部感染常见的病原菌,存在多药耐药性,应根据监测结果临床要合理使用抗菌药物,以此减少新耐药株的形成,同时降低医院感染的发生。OBJECTIVE To investigate pathogens of pulmonary infection in patients with coronary heart disease after stent implantation and provide reference for rational use of antimicrobial drugs. METHODS A total of 240 patients with coronary artery disease who underwent stent implantation during Oct. 2010 to Oct. 2013 were selected. Pathogen isolation was performed on sputum specimens, and the susceptibility test was conducted. RESULTS Ninety eight pathogens were isolated from the 240 specimens, the detection rate was 40.83%. Among the detected pathogens, there were 46 strains of gram-negative bacteria, accounting for 46.94%, mainly Pseudo- monasaeruginosa （13 strains, 13. 26%）; followed by 8 strains of Acinetobacter baumannii, accounting for 8.16% ; 28 strains of gram-positive bacteria, accounting for 28.57%, mainly Staphylococcus aurous （9 strains, 9.18%） ; followed by 8 strains of Staphylococcus haemolyticus （9. 16%） ; 24 strains of fungi, accounting for 24.49%, mainly Candida albicans （16 strains, 16. 33%）. Gram-negative bacteria had a high resistance of 85.00% to aztreonam, ampicillin, ampicillin/sulbactam, ceftriaxone, and cefazolin. Gram-positive bacteria had a high resistance to clindamycin, ievofloxacin, erythromycin, and penicillin, with the majority of resistance up to 100.00%. The resistance rate of C. albicans was generally low. CONCLUSION C. albicans, P. aeruglnosa,Staphylococcus are the common pathogens of pulmonary infection after stent implantation in patients with coronary heart disease. As they have multi-drug resistance, the clinical use of antibiotics should be reasonable based on monitoring results, thus reducing the formation of new resistant strains and reducing hospital infection.

关 键 词：冠心病 支架植入术 肺部感染 病原菌 耐药性 

分 类 号：R563[医药卫生—呼吸系统]