急性脑梗死患者肺部感染病原菌分布与耐药性研究  

Clinical analysis of pathogens causing pulmonary infections in patients with acute cerebral infarction

作　　者：王欣[1] 施婵宏[1] 楼翰健[1] 

机构地区：[1]义乌市中心医院神经内科,浙江义乌322000

出　　处：《中华医院感染学杂志》2015年第20期4602-4603,4609,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2013KYA124)

摘　　要：目的探讨急性脑梗死患者肺部感染发生率及肺部感染病原菌分布与耐药性,为临床诊治提供依据。方法回顾性分析医院2009年1月-2014年6月收治的1 462例急性脑梗死患者临床资料,调查分析肺部感染发生率,了解其感染病原菌种类及其耐药性,调查数据采用Excel软件进行处理,采用Whonet 5.4软件进行药敏统计分析。结果 1 462例急性脑梗死患者发生肺部感染82例,感染率为5.6%;共分离出病原菌107株,革兰阴性菌69株占64.5%,其中以肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主,分别占19.6%、13.1%和9.3%,革兰阳性菌29株占27.1%,主要以肺炎链球菌和金黄色葡萄球菌为主,分别占11.2%和9.3%,真菌9株占8.4%,其中白色假丝酵母菌占5.6%;主要革兰阴性菌对美罗培南和亚胺培南的耐药率较低,为0～4.8%;主要革兰阳性菌对万古霉素、亚胺培南和利奈唑胺的耐药率较低,为0～16.7%;真菌对氟康唑、伏立康唑和酮康唑耐药率较低,为0～20.0%。结论急性脑梗死患者肺部感染发生率较高,临床应积极采取预防治疗措施,减少感染的发生;若已发生感染,应参考药敏试验结果选用适宜的抗菌药物,以提高临床治疗效果。OBJECTIVE To investigate distribution and drug resistance of pathogens causing pulmonary infections in patients with acute cerebral infarction ,so as to provide references for clinical diagnosis and treatments .METHODS The clinical data of 1462 cases with acute cerebral infarction treated in our hospital from Jan .2009 to Jun .2014 were retrospectively analyzed .The incidence rate of pulmonary infections ,the distribution and drug resistance of pathogenic bacteria were investigated .All data were statistically analyzed by Excel and Whonet 5 .4 was used to deal with drug sensitivity results .RESULTS Totally 82 cases were found to be infected out of 1462 ,and the infec‐tion rate was 5 .6% .A total of 107 strains of pathogenic bacteria were isolated ,and the main pathogenic bacteria were gram‐negative bacteria with 69 strains （64 .5% ） ,including K lebsiella pneumoniae （19 .6% ） , Pseudomonas aeruginosa （13 .1% ） and Escherichia coli （9 .3% ） .And 29 strains of gram‐positive bacteria （27 .1% ） were isola‐ted ,mainly including Streptococcus pneumoniae （11 .2% ） and Staphylococcus aureus （9 .3% ） .Totally 9 strains of fungi were isolated ,and most of fungi were Candida albicans （5 .6% ） . The main gram‐negative bacteria showed lower drug resistance to meropenem and imipenem ,and the rate of drug resistance was 0~4 .8% .The main gram‐positive bacteria showed lower drug resistance to vancomycin ,imipenem and linezolid ,and the rate of drug resistance was 0~16 .7% .Fungi showed lower drug resistance to fluconazole ,voriconazole and ketocon‐azole ,and the rate of drug resistance was 0~20 .0% .CONCLUSION The incidence rate of pulmonary infection in acute cerebral infarction was high ,and the active prevention measures should be carried out to reduce the infec‐tion .If the infection has occurred ,the antibiotics should be selected referring to the result of drug sensitive test to improve the clinical effect .

关 键 词：急性脑梗死 肺部感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]