重症监护病房脑卒中后肺炎患者多药耐药菌感染病原学检测分析

范路梅 魏红 谢小红

[摘要]目的 分析重癥监护病房（ICU）脑卒中后肺炎患者多药耐药菌感染的病原学分布。方法 回顾性分析2014年6月～2018年6月我院ICU收治的190例脑卒中后肺炎患者的临床资料，对其进行多药耐药菌感染病原学分布及耐药性分析。结果 190例ICU脑卒中后肺炎患者中，共有110例并发多药耐药菌感染，感染率为57.89%。分离培养出多药耐药菌病原200株，其中革兰阴性菌148株，占74.0%，革兰阳性菌49株，占24.50%，真菌3株，占1.50%。革兰阴性杆菌中，铜绿假单胞菌对氨苄西林、头孢曲松的耐药率较高;肺炎克雷伯菌对庆大霉素的耐药率较高;鲍氏不动杆菌对氨苄西林、氨曲南、头孢曲松的耐药率较高。革兰阳性杆菌中，金黄色葡糖球菌对青霉素、红霉素、环丙沙星、四环素、氨苄西林及庆大霉素的耐药率较高;溶血葡糖球菌对青霉素、红霉素、环丙沙星、氨苄西林及庆大霉素的耐药率较高;表皮葡糖球菌对四环素、红霉素的耐药率较高。结论 多药耐药菌所占比例较高，对多重抗生素呈广泛的不同程度的耐药，临床上应科学选择耐药率抗菌药物进行治疗。

[关键词]脑卒中;肺炎;多药耐药菌;病原学

[中图分类号] R563          [文献标识码] A          [文章编号] 1674-4721（2019）7（c）-0101-04

[Abstract] Objective To analyze the pathogenic distribution of multidrug resistant bacterial infections in patients with post-stroke pneumonia in intensive care unit （ICU）. Methods The clinical data of 190 patients with post-stroke pneumonia admitted to ICU of our hospital from June 2014 to June 2018 were were retrospectively analyzed. The pathogenic distribution and drug resistance of multi-drug resistant bacterial infections were analyzed. Results Among 190 ICU patients with post-stroke pneumonia， a total of 110 patients with post-stroke pneumonia in ICU were infected with multidrug-resistant bacteria， the infection rate was 57.89%. Two hundred strains of multidrug-resistant bacteria were isolated and cultured， including 148 strains of gram-negative bacteria， accounted for 74.0%， 49 strains of gram-positive bacteria， accounted for 24.50%， and 3 strains of fungi， accounted for 1.50%. Among gram-negative bacilli， the resistence rate of pseudomonas aeruginosa was higher to Ampicillin and Ceftriaxone; the resistence rate of klebsiella pneumoniae was higher to Gentamicin， and the resistence rate of acinetobacter bauxii was higher to Ampicillin， Amtraline and Ceftriaxone. Among gram-positive bacteria， the resistence rate of staphylococcus aureus aureus were higher to Penicillin， Erythromycin， Ciprofloxacin， Tetracycline， Ampicillin and Gentamicin， the resistence rate of hemolytic glucococcus was higher to Penicillin， Erythromycin， Ciprofloxacin， Ampicillin and Gentamicin， and the resistence rate of glucococcus epidermidis was higher to Tetracycline and Erythromycin. Conclusion Multidrug-resistant bacteria account for a high proportion and are widely resistant to multiple antibiotics in varying degrees. Sensitive antibiotics should be scientifically selected for clinical treatment.

[Key words] Stroke; Pneumonia; Multidrug resistant bacteria; Etiology