脑卒中患者肺部感染的病原菌分布与耐药性分析  

Pathogen distribution and drug resistance analysis of pulmonary infections in patients suffered from stroke

作　　者：王雪晴[1] 林红[2] 陈红涛[3] 刘汉伟[4] 周武 

机构地区：[1]中山大学第五附属医院高压氧,广东珠海519000 [2]中山大学第五附属医院门诊部,广东珠海519000 [3]中山大学第五附属医院检验科,广东珠海519000 [4]中山大学第五附属医院神经内科,广东珠海519000 [5]珠海市第二人民医院神经内科,广东珠海519000

出　　处：《中华医院感染学杂志》2015年第12期2695-2697,共3页Chinese Journal of Nosocomiology

基　　金：珠海市科技局科技基金资助项目(PC20081085)

摘　　要：目的探讨脑卒中并发肺部感染患者的病原菌分布以及对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法收集2011年10月-2013年9月收治的436例脑卒中患者临床资料,对其中发生肺部感染患者的病原菌分布及其对抗菌药物的耐药率进行回顾性分析,研究数据采用SPSS13.0软件进行统计。结果 436例脑卒中患者并发肺部感染34例,感染率7.8%;34例卒中后肺部感染患者痰培养阳性29例,阳性率85.0%,共分离出病原菌70株,其中革兰阴性菌52株占74.3%、革兰阳性菌12株占17.1%、真菌6株占8.6%;革兰阴性菌中肺炎克雷伯菌对氨苄西林及头孢呋辛的耐药率较高,分别为100.0%及81.0%,铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢曲松的耐药率均达100.0%;革兰阳性菌中金黄色葡萄球菌对青霉素的耐药率为100.0%;对呋喃妥因、磺胺甲噁唑/甲氧苄啶、利奈唑胺、替加环素及万古霉素耐药率均为0;表皮葡萄球菌对苯唑西林、磺胺甲噁唑/甲氧苄啶、利福平以及四环素等耐药率均达100.0%。结论脑卒中患者并发肺部感染的病原菌以革兰阴性菌为主,临床应结合药敏试验合理使用抗菌药物,以期达到最佳的治疗效果。OBJECTIVE To determine the features of pathogens and drug resistance to antibiotics in pneumonia patients after stroke so as to provide references for reasonable use of antibiotics in clinic .METHODS Totally 436 cases of patients from Oct .2011 to Aug .2013 were selected and their clinical data were analyzed .Pathogen distribution and drug resistance rate to antibiotics were retrospectively analyzed in patients with pulmonary infections .All data were analyzed by SPSS 13 .0 software .RESULTS A total of 34 patients with stroke were complicated with pulmonary infections and the infection rate was 7 .8% .Among them ,29 cases were positive in sputum culture with the positive rate of 85 .0% .Totally 70 strains of pathogens were isolated in the samples , including 52 strains of gram‐negative bacteria ,accounting for 74 .3% and 12 strains of gram‐positive bacteria , holding 17 .1% and 6 strains of fungi ,which accounted for 8 .6% .K lebsiella pneumonia had high drug resistance to ampicillin and cefuroxime （100% and 81 .0% ） . Pseudomonas aeruginosa was 100% resistant to ampicillin , ampicillin/sulbactam ,cefazolin and ceftriaxone .In gram‐positive bacteria , Staphylococcus aureus was 100 .0%resistant to penicillin , while not resistant to macrodantin , sulfamethoxazole/trimethoprim , linezolid and vancomycin .Staphylococcus epidermidis were 100 .0% resistant to oxacillin ,sulfamethoxazole/trimethoprim , rifampicin and tetracycline .CONCLUSION Gram‐negative bacteria are the major pathogens causing pulmonary infections in patients with stroke .Antibiotics should be reasonably used according to drug sensitive test to reach their best curative effect .

关 键 词：脑卒中 肺部感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]