急性重症脑卒中患者并发院内获得性肺炎的病原菌分布及耐药性分析

摘要

Objective investigate the distribution and antibiotic resistance of pathogens isolated from patients with acute severe stroke accompanyied with hospital acquired pneumonia.Methods The clinical data of 225 patients with acute severe stroke accompanied with hospital acquired pneumonia in NICU from Jan 2011 to May 2012 were analyzed retrospectively.Results 11 pathogenic microorganisms and 121 strains were cultivated among the 225 cases accompanied with nosocomial pneumonia.Gram negative bacilli,gram positive bacteria and fungi accounted for 68.60％,29.75％ and 1.65％,respectively.Among gram negative bacilli,the most common pathogens were Pseudomonas aeruginosa,Escherichia coli and Acinetobacter baumannii.Staphylococcus aureus was the most prominent of gram positive bacteria.All strains of fungi were Candida albicans.The drug resistance rate of Acinetobacter baumannii and Pseudomonas aeruginosa strains to carbapenems antibiotics was 78.4％,83.3％ respectively while Escherichia coli and klebsiella pneumoniae strains were 100％ sensitive to carbapenems antibiotics.The drug resistance rate of Staphylococcus aureus to penicillins antibiotics was above 90％,but none of Staphylococcus aureus strains was resistant to vancomycin.Conclusion Gram negative bacilli and gram positive bacteria were the main pathogens for patients with acute severe stroke accompanyied with nosocomial pneumonia,but Gram negitive bacteria were the leading ones.Antibiotics should be rationally used according to the results of susceptibility testing.The NICU should enhance monitoring and control of antibiotics in order to help patients to recover quickly.%目的 了解医院急性重症脑卒中患者并发院内获得性肺炎(hospital acquived peneumonia,HAP)的病原菌分布及耐药性,以指导临床抗生素的合理使用.方法 回顾分析湖北省武汉市第一医院神经内科重症监护病房自2011年1月——2012年5月收治的225例急性重症脑卒中并发HAP患者的临床资料.结果 在225例患者中分离出11种共121株致病菌,其中以革兰阴性杆菌为主,占68.60％,主要为铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌等；革兰阳性菌占29.75％,主要为金黄色葡萄球菌；真菌占1.65％,为白假丝酵母菌.鲍曼不动杆菌和铜绿假单胞菌的耐药率高,对碳青霉烯类抗生素已分别产生了78.4％ 、83.3％的耐药率,而大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗生素保持了100％的敏感性,金黄色葡萄球菌对青霉素类抗生素的耐药率达90％以上,但尚未发现对万古霉素的耐药菌株.结论 急性重症脑卒中患者并发HAP的主要致病菌为革兰阴性菌.这些主要致病菌多为条件致病菌,且都有很强的耐药性.因此临床上应结合药敏试验科学合理用药,神经内科重症监护病房加强监测与控制,以期快速治愈患者.