老年急性脑卒中患者医院获得性肺炎的病原菌分布与耐药性监测  

Distribution and drug resistance of pathogens causing hospital-acquired pneumonia in elderly patients with acute stroke

作　　者：牟静[1] 陈慧[1] 

机构地区：[1]日照市人民医院护理部,山东日照276826

出　　处：《中华医院感染学杂志》2014年第9期2122-2124,共3页Chinese Journal of Nosocomiology

基　　金：日照市卫生局基金资助项目(SR-2010B-1023)

摘　　要：目的监测并分析老年急性脑卒中患者医院获得性肺炎(HAP)的病原菌分布及耐药性,为临床用药提供参考。方法选择医院2012年3月-2013年3月42例老年急性脑卒中合并HAP患者资料进行回顾性分析,采用ATB-Expression分析仪对培养的病原菌进行鉴定,药敏试验采用K-B纸片法。结果共培养出病原菌57株,其中革兰阴性菌36株占63.16%,前3位菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,分别占17.54%、14.04%、8.77%,革兰阳性菌18株占31.58%,前3位菌依次为金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌,分别占12.28%、8.77%、7.01%,真菌3株占5.26%,以白色假丝酵母菌和热带假丝酵母菌为主,分别占3.51%、1.75%;革兰阴性菌中肺炎克雷伯菌及其他病原菌对氨苄西林、左氧氟沙星、庆大霉素、头孢曲松、头孢噻肟、氨苄西林/舒巴坦等临床常用抗菌药物的耐药率均>50.0%,对美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦较敏感;革兰阳性菌对青霉素、左氧氟沙星、克林霉素普遍耐药,未发现耐万古霉素的菌株。结论随着抗菌药物的广泛应用,老年急性脑卒中HAP患者的病原菌耐药率居高不下,加强治疗中各环节的感染控制,杜绝或降低医源性感染,做好消毒隔离,避免患者间交叉感染,是预防和控制医院感染的重要举措,同时应避免在同一病区长时间使用同一种抗菌药物,以控制耐药菌株的滋生。OBJECTIVE To analyze the distribution and drug resistance of pathogens causing hospital-acquired pneumonia in elderly patients with acute stroke so as to provide guidance for clinical medication.METHODS A total of 42elderly patients with acute stroke complicated with hospital-acquired pneumonia,who were treated in the hospital from Mar 2012to Mar 2013,were enrolled in the study,then the clinical data of the patients were retrospectively analyzed,the identification of the isolated pathogens was carried out by using ATB-Expression analyzer,and the drug susceptibility testing was performed with the use of K-B method.RESULTS A total of 57strains of pathogens have been isolated,including 36（63.16%）strains of gram-negative bacteria,18（31.58%）strains of grampositive bacteria,and 3（5.26%）strains of fungi;the Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosaranked the top three species of gram-negative bacteria,accounting for 17.54%,14.04%,and 8.77%, respectively;Staphylococcus aureus,Staphylococcus haemolyticus and Staphylococcus epidermidis ranked the top three species of gram-positive bacteria,accounting for 12.28%,8.77%,and 7.01%,respectively;the Candida albicans and Candida tropicalis were the predominant species of fungi,accounting for 3.51% and 1.75%,respectively.The drug resistance rates of the K.pneumoniae and other species of gram-negative bacteria to ampicillin,levofloxacin,gentamicin,ceftriaxone,cefotaxime,and ampicillin-sulbactam were more than 50.0%,while the drug susceptibility rates to meropenem,imipenem,piperacillin-tazobactam,and cefoperazone-sulbactam were high;the gram-positive bacteria were widely resistant to penicillin,levofloxacin,and clindamycin,and no vancomycin-resistant strains have been detected.CONCLUSION With the extensive use of antibiotics,the drug resistance rates of the pathogens causing hospital-acquired pneumonia show upward trend.It is an effective way to strengthen the control of infections in each link,reduce the incidence of iatrogenic infections,perform

关 键 词：老年患者 急性脑卒中 医院获得性肺炎 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]