老年重症脑卒中患者医院获得性肺炎的病原微生物分布特征及其耐药性分析  

Distribution characteristics and drug resistance of pathogenic microorganisms in elderly patients with hospital acquired pneumonia after severe cerebral apoplexy

作　　者：余华为 Yu Hua-wei(Pharmacy Department of Jianli County People’s Hospital,Jianli 433300)

机构地区：[1]监利县人民医院药剂科,监利433300

出　　处：《中国抗生素杂志》2020年第7期718-722,共5页Chinese Journal of Antibiotics

摘　　要：目的明确老年重症脑卒中患者医院获得性肺炎(hospital acquired pneumonia, HAP)的病原微生物分布特征和耐药性,为临床医师选择合理抗生素提供理论依据。方法回顾性分析2017年1月至2019年1月期间本院重症监护室(intensive care unit, ICU)收治的254例老年重症脑卒中患者HAP的临床资料,全部患者均进行痰细菌培养、菌种鉴定与药敏试验。结果 254例老年重症脑卒中继发HAP患者共分离病原微生物270株,病原微生物分布以革兰阴性菌为主,占67.04%,明显高于革兰阳性菌的32.96%,两者比较差异具有统计学意义(P<0.05)。主要病原微生物依次为肺炎克雷伯菌(Klebsiella pneumoniae,KP)、鲍曼不动杆菌(Acinetobacter baumannii,AB)、金黄色葡萄球菌(Staphylococcus aureus,SA)、铜绿假单胞菌(Pseudomonas aeruginosa,PA)、表皮葡萄球菌(Staphylococcus epidermidis,SE),分别占22.96%、20.74%、16.67%、15.19%和11.11%。药敏试验结果显示,KP对美罗培南、亚胺培南敏感,SA、SE对万古霉素敏感,耐药率均为0。AB、PA对美罗培南、亚胺培南和环丙沙星相对敏感,SA、SE对夫西地酸、复方磺胺甲噁唑、利福平相对敏感,耐药率<40.00%。KP、PA对氨苄西林、头孢氨苄、头孢唑林的耐药,耐药率>90%,AB对氨曲南、庆大霉素、氨苄西林耐药,SA、SE对氨苄西林、青霉素耐药,耐药率均为100.00%。结论老年重症脑卒中患者HAP的病原微生物分布以革兰阴性菌为主,常见病原微生物均具有严重的耐药现象,应结合药敏试验结果合理选择抗生素,避免多重耐药菌的出现。Objective To clarify the distribution characteristics and drug resistance of pathogenic microorganisms in elderly patients with hospital acquired pneumonia(HAP) after severe cerebral apoplexy, so as to provide a theoretical basis for clinicians to select rational antibiotics. Methods The clinical data of HAP in 254 cases of elderly patients with severe cerebral apoplexy admitted to intensive care unit(ICU) from our hospital during the period of January 2017 to January 2019 were retrospectively analyzed. All patients underwent sputum bacterial culture, strain identification and drug sensitivity test. Results A total of 270 strains of pathogenic microorganisms were isolated from 254 cases of elderly patients with HAP after severe cerebral apoplexy. The distribution of pathogenic microorganisms mainly was Gram-negative bacteria, accounting for 67.04%, which was significantly higher than 32.96% of Gram-positive bacteria, the difference between both was statistically significant(P<0.05).The pathogenic microorganisms were given priority to KP, AB, SA, PA and SE, which respectively accounted for 22.96%, 20.74%, 16.67%, 15.19% and 11.11%. The drug sensitivity test results showed that KP was sensitive to meropenem and imipenem, SA and SE were sensitive to vancomycin, and the drug resistance rate was 0. AB and PA were relatively sensitive to meropenem, imipenem and ciprofloxacin, while SA and SE were relatively sensitive to fusidic acid, compound xinnomin and rifampicin, the drug resistance rate <40.00%. KP and PA were resistance to ampicillin, cephalexin and cefazolin, the drug resistance rate>90%, AB were resistance to ampicillin, gentamicin and ampicillin, SA and SE were resistance to ampicillin and penicillin, the drug resistance rate=100.00%. Conclusion The pathogenic microorganism distribution of HAP in elderly patients with severe cerebral apoplexy mainly is Gramnegative bacteria, and major pathogenic microorganism have serious drug resistance. Therefore, antibiotics should be reasonably selected in combination with

关 键 词：脑卒中 重症医学 老年 医院获得性肺炎 病原微生物 耐药现象 

分 类 号：R378[医药卫生—病原生物学]