Objective To investigate distribution and characteristics of antibiotic resistance of sputum pathogens for stroke-associated pneumonia (SAP) in emergency intensive care unit (EICU).Methods Pathogenic bacteria were isolated from sputum specimens of SAP patients in EICU of our hospital.Then,the distribution and the drug resistance of the pathogenic bacteria were investigated.Results Out of the 235 SAP patients,there were 132 patients that sputum culture results were positive,the culture-positive rate was 56.2％.A total of 232 isolates were available from these patients.Of all the isolates,156 strains were Gram negative bacteria (67.2％),31 strains were Gram positive bacteria (13.4％);40 strains were Gram positive bacteria (17.2％);and 5 strains were fungi (2.2％).The top four Gram negative bacteria were as follows:Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii and Escherichia coli.The ratio of the extended spectrum β-lactamases (ESBLs) producing strains in Klebsiella pneumoniae and Escherichia coli is high.Both Pseudomonas aeruginosa and Acinetobacter baumannii had high resistant rates against antibiotics,and they were characterized by multiple drug resistance.The Gram positive bacteria mainly were Staphylococcus aureus and Enterococcus.The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 62.5％,and they were all sensitive to vancomycin,linezolid or teicoplanin.While Enterococcus had high resistant rates against penicillin,quinolones and macrolide antibiotics,they had low resistant rates against vancomycin,linezolid or teicoplanin.Anaerobic bacteria included Bacteroides fragilis,Peptostreptococcus and Black-pigmented bacteria,and the cases mainly were mixed polymicrobial infections.Conclusion In EICU,Gram-negative bacteria are the predominant pathogens of SAP.Anaerobic bacteria and mixed polymicrobial infections are common in these patients,and there is a serious situation of antibiotic resistance.Studying on distribution and antibiotic resistance of pathogens might contribute to achieve rational prevention and tailored antibiotic treatment for SAP.%目的 探讨急诊重症监护病房(emergency intensive care unit,EICU)中卒中相关性肺炎(stroke associated pneumonia,SAP)的病原菌分布及其耐药性特点.方法 对2015-01 ～2016-12入住首都医科大学附属北京天坛医院EICU的SAP患者痰培养结果进行分析,分析其病原菌分布及耐药情况.结果 235例SAP患者中有132例下呼吸道标本培养阳性,阳性率为56.2％,共检出病原菌232株,其中革兰阴性(G-)菌156株,占67.2％;革兰阳性(G+)菌31株,占13.4％;厌氧菌40株,占17.2％;真菌5株,占2.2％.G-菌主要为肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌和大肠埃希菌,肠杆菌中肺炎克雷伯杆菌和大肠埃希菌产超广谱β-内酰胺酶(extended spectrumβ lactamases,ESBLs)菌株比例较高;非发酵菌中铜绿假单胞菌和鲍曼不动杆菌耐药率较高,且具有多重耐药性.G+菌主要为金黄色葡萄球菌和肠球菌属,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)的比例为62.5％,对万古霉素、利奈唑胺和替考拉宁均敏感(100％);肠球菌属对青霉素类、喹诺酮类和大环内酯类抗菌药物耐药率均较高,对万古霉素、利奈唑胺和替考拉宁耐药率较低.厌氧菌主要包括脆弱拟杆菌、消化链球菌、产黑色素类杆菌,多为混合感染.结论 EICU中SAP的常见病原菌以G-菌为主,厌氧菌感染和混合感染比例较高,病原菌耐药形势严峻.针对病原菌分布和耐药性进行分析,有助于合理选择感染控制措施和抗菌药物.
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