老年脑卒中相关性肺炎病原菌分布及对抗生素的耐药性

摘要

Objective To investigate the pathogen distribution and antibiotic resistance of stroke-associated pneumonia in elderly pa-tients. Methods A total of 231 elderly patients with stroke-associated pneumonia were collected. Sputum culture and susceptibility test was taken and the results were analyzed. Results Pathogens were detected in 135 patients,with the total positive rate of 58. 44%,including 86 iso-lates of Gram-negative bacteria(63. 70%),23 isolates of Gram-positive bacteria(17. 03%)and 26 isolates of fungi(19. 26%). Mixed in-fections accounted for 18.51%. Gram -negative bacteria mainly included Klebsiella pneumoniae(K. pneumoniae)(27 isolates,20. 0%), Acinetobacter baumannii(A. baumannii)(17 isolates,12. 60%),and Pseudomonas aeruginosa(P. aeruginosa)(14 isolates,10. 37%). Gram-positive bacteria included Staphylococcus aureus(13 isolates,9. 63%),Streptococcus pneumoniae(7 isolates,5. 19%),and coagulase-positive staphylococci(3 isolates,2. 22%). Candida albicans is the most common fungus(17 isolates,12. 0%). The susceptibility test showed that the isolates of K. pneumoniae was sensitive to imipenem,cefepime,etc;A. baumannii was sensitive to imipenem,cefoperazone/sul-bactam,amikacin,etc.;P. aeruginosa was sensitive to imipenem,cefepime,amikacin and so on. Extended spectrum β-lactamases( ESBLs) producing Gram-negative bacteria were identified in two isolates of K. pneumoniae and one isolate of Escherichia coli. Conclusion The patho-gens responsible for the stroke-associated pneumonia were mainly Gram-negative. Overuse of antibiotics should be controlled in order to reduce the generation of resistant strains.%目的：探讨老年脑卒中相关性肺炎病原菌分布及对抗生素的耐药性。方法选择脑卒中相关性肺炎的老年患者231例，进行痰培养及药敏试验，并分析。结果135例患者检出病原体，总阳性率为58.44％，其中包括革兰阴性菌共86株（63.70％），革兰阳性菌共23株（17.03％），真菌26株（19.26％），其中混合感染占18.51％。革兰阴性菌中主要包括：肺炎克雷伯杆菌有27株（20.0％），鲍曼不动杆菌17株（12.60％），铜绿假单胞菌14株（10.37％）。革兰阳性菌中包括金黄色葡萄球菌13株（9.63％），肺炎链球菌7株（5.19％），凝固酶阳性葡萄球菌3株（2.22％）。真菌中白假丝酵母菌最为多见，有17株（12.0％）。对肺炎克雷伯杆菌敏感的抗生素有亚胺培南、头孢吡肟等；对鲍曼不动杆菌较敏感的抗生素有亚胺培南、头孢哌酮/舒巴坦、阿米卡星等；对铜绿假单胞菌较敏感的抗生素有亚胺培南、头孢吡肟、阿米卡星等。革兰阴性菌中检出产超广谱β-内酰胺酶（ESBLs）菌共3株，其中肺炎克雷伯杆菌2株，大肠埃希菌1株。结论脑卒中患者并发肺部感染的病原体主要为革兰阴性菌，应控制抗生素的滥用，以减少耐药菌株的产生。