高血压脑出血患者合并肺部感染的病原菌分布及易感因素分析  

Pathogen distribution and predisposing factors of pulmonary infection in patients with hypertensive cerebral hemorrhage

作　　者：孟晓峰[1] 史保中[1] 乔鹏[1] 陆兆丰[1] 李兵[1] 张晓辉[1] 

机构地区：[1]河南科技大学第一附属医院神经外科,河南洛阳471000

出　　处：《中华医院感染学杂志》2017年第3期569-572,共4页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅医学科技攻关计划项目(20157822)

摘　　要：目的分析高血压脑出血患者住院期间合并肺部感染的病原菌分布及易感因素,为临床诊疗提供指导依据。方法选取2012年5月-2016年5月住院保守治疗并合并肺部感染的72例高血压脑出血患者(观察组),另选取同时期未合并肺部感染的80例高血压脑出血患者(对照组)进行易感因素对比分析,采用微生物半自动鉴定系统进行细菌分离及鉴定,通过纸片扩散法(K-B法)进行药物敏感性试验,分析患者感染病原菌的分布及药敏试验结果。结果观察组患者年龄>60岁以上,合并基础糖尿病及慢性支气管炎,合并吞咽功能障碍及营养不良,住院期间联合使用抗菌药物超过3周的患者,合并肺部感染的发病率显著升高,差异均有统计学意义(P<0.05);72例患者共分离病原菌91株,其中革兰阴性菌55株占60.4%,革兰阳性菌34株占37.4%,真菌2株占2.2%;革兰阴性菌中肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌的检出率较高,分别占60.4%、30.8%和16.5%;革兰阳性菌中主要检出率较高的为肠球菌属和金黄色葡萄球菌,分别占22.0%和9.9%;真菌主要为白假丝酵母菌占2.2%;革兰阴性菌对氨基糖苷类、喹诺酮类、第三代头孢菌素等抗菌药物耐药性较高,部分可达100.0%,而对美罗培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦等仍然较敏感,革兰阳性菌对青霉素、克林霉素等普遍耐药,对万古霉素,替考拉宁,利福平等仍然较敏感。结论高血压脑出血患者住院期间合并肺部感染的易感因素为高龄,合并基础慢性病史(糖尿病及慢性支气管炎)及营养不良和广泛联合使用抗菌药物,肺部感染的病原菌主要以革兰阴性菌为主,对碳青霉烯类抗菌药物较敏感。OBJECTIVE To analyze the pathogen distribution and predisposing factors of pulmonary infection in patients with hypertensive cerebral hemorrhage,so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 72 patients with hypertensive intracerebral hemorrhage and pulmonary infection from May2012 to May 2016 in our hospital were selected（study group）,while 80 patients with no pulmonary infection were chosen（control group）for predisposing factors analysis.The bacterial isolation and identification were carried out by microbial semi-automatic identification system.The distribution of pathogenic bacteria and drug sensitivity test were analyzed by K-B disk diffusion method.RESULTS Compared with control group,the incidences of the pulmonary infection were significantly increased of patients of study group of 60 years old or older,with diabetes and chronic bronchitis basis,the joint use of antibiotics in patients with more than three weeks of malnourished patients with swallowing dysfunction and consolidation,and the differences were significant（P〈0.05）.Totally 91 strains of pathogens were isolated from 72 patients,including 55 strains of gram-negative bacteria,34 strains of gram-positive bacteria,and 2stains of fungi,accounting for 60.4%,37.4%,and 2.2%,respectively.The detection rates of Klebsiella pneumonia, Acinetobacter baumannii and Escherichia coli in gram-negative bacteria were high,accounting for 60.4%,30.8% and 16.5%,respectively.The positive rates of Enterococcus and Staphylococcus aureus in gram-positive bacteria were high,accounting for 22.0% and 9.9%.The main fungus is Candida albicans,accounting for 2.2%.The gram-negative bacteria had high drug resistant rates to amino aminoglycosides,quinolones and the third generation of cephalosporins,some up to 100.0%,and were still sensitive to meropenem,imipenem,amikacin,and cefoperazone/sulbactam.The gram-positive bacteria were generally resistant to penicillin and clindamycin,but were still sensitive to vancomycin,teicoplanin,and

关 键 词：高血压 脑出血 肺部感染 病原菌 

分 类 号：R378[医药卫生—病原生物学]