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目的:分析脑卒中患者医院获得性肺炎的病原菌分布及药敏性,为临床合理使用抗菌药物提供依据。方法:收集2013年3月-2015年9月我院收治的109例脑卒中并发医院获得性肺炎的临床资料,采用无菌方法收集患者晨痰或者下呼吸道分泌物进行细菌培养,并对阳性病原菌进行药物敏感性试验。结果:对痰标本或者是下呼吸道分泌物进行细菌培养187次,培养阳性152次,阳性率为81.28%,共培养出病原菌283株,其中革兰阴性菌192株占67.84%,革兰阳性菌76株占26.86%,真菌15株占5.30%。革兰阴性菌中的肺炎克雷伯菌,鲍氏不动杆菌,大肠埃希菌,铜绿假单胞菌,阴沟肠杆菌对头孢噻肟,头孢呋辛,美洛西林,美洛西林,头孢呋辛和头孢噻肟的耐药率最高,分别为66.18%,65.31%,70.97%,64.00%,71.43%;对氯霉素,哌拉西林/他唑巴坦,氯霉素,头孢吡肟,氯霉素的耐药率最低,分别为1.47%,6.12%,3.23%,8.00%,7.14%。革兰阳性菌中的金黄色葡萄球菌,肺炎链球菌,粪肠球菌对万古霉素,万古霉素,氨苄西林的耐药率最高,分别100.00%,90.00%,84.62%;对红霉素,红霉素,红霉素的耐药率最低,分别为5.26%,0.00%,0.00%。结论:革兰阴性菌是脑卒中患者医院获得性肺炎的主要病原菌,病原菌耐药性高且存在耐多药现象,临床应合理选用抗菌药物进行治疗。
OBJECTIVE: To analyze the distribution and drug sensitivity of pathogenic bacteria in hospital-acquired pneumonia in stroke patients and to provide basis for rational use of antimicrobial agents in clinic. Methods: The clinical data of 109 cases of stroke complicated with hospital-acquired pneumonia admitted in our hospital from March 2013 to September 2015 were collected. Bacterial culture was performed by collecting the patients’ morning sputum or lower respiratory secretions by aseptic method. The positive pathogens Conduct drug susceptibility testing. Results: Bacterial culture was performed on sputum samples or lower respiratory tract secretions for 187 times, with a positive rate of 152.2% and a positive rate of 81.28%. A total of 283 pathogenic bacteria were co-cultivated, of which 192 strains were gram-negative bacteria accounting for 67.84% 76 strains accounted for 26.86%, fungi 15 strains accounted for 5.30%. Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, cefotaxime, cefuroxime, mezlocillin, mezlocillin, Furosemide and cefotaxime had the highest resistance rates of 66.18%, 65.31%, 70.97%, 64.00% and 71.43%, respectively. For chloramphenicol, piperacillin / tazobactam, chloramphenicol and cefepime , The lowest rate of chloramphenicol resistance, respectively, 1.47%, 6.12%, 3.23%, 8.00%, 7.14%. Gram-positive bacteria Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis vancomycin, vancomycin, ampicillin, the highest rate of resistance were 100.00%, 90.00%, 84.62%; erythromycin, The lowest rates of erythromycin and erythromycin were 5.26%, 0.00% and 0.00% respectively. Conclusion: Gram-negative bacteria are the main pathogens of hospital-acquired pneumonia in stroke patients. The pathogens are highly drug-resistant and have multidrug-resistant phenotypes. Clinically, antimicrobial agents should be selected for rational treatment.