急性脑梗死患者合并医院感染的病原菌分布及耐药性分析  

Analysis of pathogen distribution and drug resistance in patients with acute cerebral infarction complicated by hospital infection

作　　者：刘文慧 崔云虹 闫利明[2] LIU Wenhui;CUI Yunhong;YAN Liming(Hetao College Department of Medicine,Bayannor 015000,Mongolian,China;Bayannur City Hospital)

机构地区：[1]河套学院医学系,内蒙古巴彦淖尔015000 [2]巴彦淖尔市医院

出　　处：《中国病原生物学杂志》2024年第5期591-594,共4页Journal of Pathogen Biology

基　　金：内蒙古自治区教育厅自然科学基金(No.NJZY12276)。

摘　　要：目的分析急性脑梗死患者合并医院感染的病原菌分布特点、耐药性及医院感染对患者免疫功能的影响。方法选取85例本院接诊的急性脑梗死合并医院感染患者为本次研究对象,同时选取同期80例未发生院内感染的急性脑梗死患者为对照组。无菌采集不同感染部位患者的痰液、尿液、粪便、皮肤分泌物等分泌物进行病原菌鉴定及药敏试验。采用流式细胞术测定感染组与对照组患者T淋巴细胞亚群水平,进行对比分析。结果85例急性脑梗死合并医院感染患者中,共发生88处感染,主要为单一部位感染。其中,45.45%为下呼吸道感染,然后依次为泌尿系统、上呼吸道、消化系统、口腔、皮肤软组织。共检出病原菌92株,革兰阴性菌占比55.43%,革兰阴性菌占比34.78%,真菌占比9.78%。革兰阴性菌主要为肺炎克雷伯菌、铜绿假单胞菌,革兰阳性菌主要为肺炎链球菌、金黄色葡萄球菌,真菌主要为白色假丝酵母菌。革兰阴性菌对哌拉西林/他唑巴坦、亚胺培南、美罗培南、阿米卡星较敏感,对氨苄西林、环丙沙星、庆大霉素的耐药率较高。革兰阳性菌中,未检出对万古霉素、替考拉宁、替加环素、利奈唑胺的耐药株,对青霉素、红霉素、克林霉素、庆大霉素、四环素、复方新诺明的耐药率较高。真菌中未检出对氟胞嘧啶的耐药株,对氟康唑、两性霉素B、伊曲康唑、伏立康唑的耐药率较低。医院感染患者CD_(3)^(+)、CD_(4)^(+)及CD_(4)^(+)/CD_(8)^(+)比值均显著低于对照组患者水平,CD8+高于对照组患者(P<0.05)。结论急性脑梗死合并医院感染患者,主要发生于下呼吸道部位,以革兰阴性菌为主。分离出的病原菌对常见抗菌药物的耐药率较高,临床应做好病原菌培养及药敏试验,根据试验结果制定针对性治疗方案。医院感染对急性脑梗死患者免疫功能具有严重影响,发生院内感染后,患者免疫功能�Objective To analyze the distribution characteristics,drug resistance,and impact of hospital acquired infections on the immune function of patients with acute cerebral infarction.Methods 85 patients with acute cerebral infarction and hospital acquired infections who were admitted to our hospital were selected as the study subjects,while 80 patients with acute cerebral infarction who did not develop hospital acquired infections during the same period were selected as the control group.The secretions were aseptically collected such as sputum,urine,feces,and skin secretions from patients with different infection sites for pathogen identification and drug sensitivity testing.The levels of T lymphocyte subsets were determined by flow cytometry in the infected group and the control group patients for comparative analysis.Results Among 85 patients with acute cerebral infarction complicated by hospital infection,a total of 88 infections occurred,mainly single site infections.Among them,45.45%were lower respiratory tract infections,followed by urinary system,upper respiratory tract,digestive system,oral cavity,and skin soft tissue.A total of 92 pathogenic bacteria were detected,with Gram negative bacteria accounting for 55.43%,Gram negative bacteria accounting for 34.78%,and fungi accounting for 9.78%.Gram negative bacteria were mainly Klebsiella pneumoniae and Pseudomonas aeruginosa,Gram positive bacteria were mainly Streptococcus pneumoniae and Staphylococcus aureus,and fungi were mainly Candida albicans.Gram negative bacteria were more sensitive to piperacillin/tazobactam,imipenem,meropenem,and amikacin,and had a higher resistance rate to ampicillin,ciprofloxacin,and gentamicin.Among Gram positive bacteria,no resistant strains to vancomycin,teicoplanin,tigecycline,and linezolid were detected,while the resistance rate to penicillin,erythromycin,clindamycin,gentamicin,tetracycline,and compound sulfamethoxazole was relatively high.No resistant strains to fluorocytosine were detected in the fungi,and the resistance rates t

关 键 词：急性脑梗死 医院感染 病原菌 免疫功能 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R446.5[医药卫生—临床医学]