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目的分析急性脑卒中合并肺部感染临床标本培养的病原菌分布、构成、耐药特点及抗菌药物敏感率调查,为医院感染的预防控制及抗菌药物合理使用提供依据。方法选取2012年1月-2014年12月收治的急性脑卒中合并肺部感染患者临床送检标本细菌培养结果 864例。按照卫生部检验操作规程进行分离培养;采用琼脂扩散法(K-B)进行药物敏感性试验;对产超广谱β-内酰胺酶(ESBL)菌、耐甲氧西林金黄色葡萄球菌(MRSA)表型检测,分析细菌种类及耐药率变迁。结果共培养患者标本864株,以G-为主,占61.2%;主要致病菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌;亚胺培南对G-菌有很高的抗菌活性,对大肠埃希菌和肺炎克雷伯菌尤为明显;利奈唑胺、万古霉素和替考拉宁对金黄色葡萄球菌有很高的抗菌活性,未发现对万古霉素耐药的金黄色葡萄球菌。环丙沙星对铜绿假单胞菌有很高的抗菌活性,阿米卡星对不动杆菌属有很高的抗菌活性,亚胺培南对铜绿假单胞菌敏感率不高。大肠杆菌连续3年ESBL检出率进行性增多,现已达为68.8%;肺炎克雷伯菌ESBL检出率高达58.7%;MRSA检出率高达46.3%。结论神经内科急性脑卒中合并肺部感染的细菌以G-为主,产ESBL菌和MRSA检出率较高,为减少耐药性应注意抗菌药物的合理使用。
Objective To analyze the distribution, composition, drug resistance and sensitivity of antimicrobial agents in clinical samples of acute stroke complicated with pulmonary infection, and provide basis for the prevention and control of nosocomial infection and rational use of antimicrobial agents. Methods A total of 864 cases of bacterial culture in clinical specimens of patients with acute stroke and pulmonary infection admitted from January 2012 to December 2014 were selected. In accordance with the Ministry of Health inspection procedures for separation and culture; using agar diffusion method (KB) drug sensitivity test; production of extended-spectrum β-lactamase (ESBL) bacteria, methicillin-resistant Staphylococcus aureus (MRSA) Type detection, analysis of bacterial species and drug resistance changes. Results A total of 864 co-cultured samples were collected from patients, accounting for 61.2% of all cases. The main pathogens were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus ; Imipenem has a very high antibacterial activity against G-bacteria, especially against Escherichia coli and Klebsiella pneumoniae; linezolid, vancomycin and teicoplanin are very high against Staphylococcus aureus The antimicrobial activity of vancomycin-resistant Staphylococcus aureus was not found. Ciprofloxacin has a high antibacterial activity against Pseudomonas aeruginosa, amikacin has a high antibacterial activity against Acinetobacter, imipenem is not sensitive to Pseudomonas aeruginosa. Escherichia coli for 3 consecutive years the detection rate of ESBL increased, now has reached 68.8%; Klebsiella pneumoniae ESBL detection rate as high as 58.7%; MRSA detection rate as high as 46.3%. Conclusions Geriatric patients with acute stroke complicated with pulmonary infection are characterized by G-type. The detection rate of ESBL-producing bacteria and MRSA is high. In order to reduce the drug resistance, we should pay attention to the rational use of antibacterials.