急性脑卒中合并肺部感染的病原菌及耐药性临床研究  

Bacteria Distribution and Drug Resistance Analysis in Patients with Acute Stroke Complicated with Pulmonary Infection

作　　者：来海欧[1] 孙继红[2] 杨竹杏[3] 刘晓琳[2] 张燕[2] 梁丽娜[4] 胡新永[1] 姬利[1] 张娜[1] 殷成龙[1] 祁占宁[1] 刘永宏[1] 

机构地区：[1]延安大学咸阳医院神经内科,陕西咸阳712000 [2]延安大学咸阳医院检验科,陕西咸阳712000 [3]延安大学咸阳医院医院感染控制办公室,陕西咸阳712000 [4]延安大学咸阳医院康复科,陕西咸阳712000

出　　处：《华西医学》2016年第2期230-234,共5页West China Medical Journal

基　　金：陕西省咸阳市科学技术研究计划项目(2014k04-11)~~

摘　　要：目的分析急性脑卒中合并肺部感染临床标本培养的病原菌分布、构成、耐药特点及抗菌药物敏感率调查,为医院感染的预防控制及抗菌药物合理使用提供依据。方法选取2012年1月-2014年12月收治的急性脑卒中合并肺部感染患者临床送检标本细菌培养结果 864例。按照卫生部检验操作规程进行分离培养;采用琼脂扩散法(K-B)进行药物敏感性试验;对产超广谱β-内酰胺酶(ESBL)菌、耐甲氧西林金黄色葡萄球菌(MRSA)表型检测,分析细菌种类及耐药率变迁。结果共培养患者标本864株,以G-为主,占61.2%;主要致病菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌;亚胺培南对G-菌有很高的抗菌活性,对大肠埃希菌和肺炎克雷伯菌尤为明显;利奈唑胺、万古霉素和替考拉宁对金黄色葡萄球菌有很高的抗菌活性,未发现对万古霉素耐药的金黄色葡萄球菌。环丙沙星对铜绿假单胞菌有很高的抗菌活性,阿米卡星对不动杆菌属有很高的抗菌活性,亚胺培南对铜绿假单胞菌敏感率不高。大肠杆菌连续3年ESBL检出率进行性增多,现已达为68.8%;肺炎克雷伯菌ESBL检出率高达58.7%;MRSA检出率高达46.3%。结论神经内科急性脑卒中合并肺部感染的细菌以G-为主,产ESBL菌和MRSA检出率较高,为减少耐药性应注意抗菌药物的合理使用。Objective To analyze the pathogenic bacteria distribution, structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection, in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents. Methods A total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014. Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health. Drug sensitivity examination was done by Kirby-Bauer（k-b）. Super-extensive spectrum β lactamase（ESBL） and methicillin resistant staphylococcus aureus（MRSA） were detected to analyze the bacterial species and resistance transition. Results A total of 864 samples were cultivated, in which G- bacteria accounted for 61.2%. The main pathogenic bacteria was Klebsiella pneumoniae bacteria, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumanmii and Staphylococcus aureus. Imipenem had high antimicrobial activity to G- bacilli, especially to Escherichia coli and Klebsiella pneumoniae bacteria. Linezolid, vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus. Vancomycin resistant Staphylococcus aureus was not found. Ciprofloxacin had high antibacterial activity to Pseudomonasaeruginosa, while imipenem had low antibacterial activity to Pseudomonas aeruginosa. Amikacin had high antibacterial activity to acinetobacter. Conclusions G- bacilli are predominant in acute stroke complicated with pulmonary infection. ESBLs and MRSA detection rate is high, and we should pay attention to the rational use of antibiotics to reduce drug resistance.

关 键 词：急性脑卒中 肺部感染 耐药性 耐甲氧西林金黄色葡萄球菌 革兰阴性杆菌 

分 类 号：R446.5[医药卫生—诊断学]