摘要
目的:探讨重症监护病房(ICU)卒中相关性肺炎患者呼吸道病原菌分布与药敏试验结果。方法:选取2019年1月至2020年12月该院收治的196例卒中相关性肺炎患者为研究对象,采集其呼吸道细菌标本并培养,统计ICU卒中相关性肺炎患者病原菌分布特点及构成,并分析革兰阴、阳性菌株对不同抗菌药物的耐药性。结果:196例ICU卒中相关性肺炎患者共分离出172株病原菌,包括38株革兰阳性菌(22.09%)、118株革兰阴性菌(68.60%)、16株真菌(9.30%)。其中革兰阴性菌株主要为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌等,革兰阳性菌株主要为凝固酶阴性葡萄球菌和金黄色葡萄球菌,真菌主要为白色假丝酵母菌。118株革兰阴性菌中,鲍曼不动杆菌对庆大霉素、头孢曲松及哌拉西林的耐药率均超过80%,铜绿假单胞菌对庆大霉素、头孢曲松、哌拉西林和头孢他啶的耐药率均超过60%,肺炎克雷伯菌对庆大霉素和哌拉西林的耐药率均超过90%,鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌对亚胺培南和美罗培南的耐药率均在20%以下;38株革兰阳性菌中,凝固酶阴性葡萄球菌对青霉素和红霉素的耐药率均在80%及以上,金黄色葡萄球菌对青霉素、红霉素、苯唑西林和环丙沙星的耐药率均在80%及以上,金黄色葡萄球菌和凝固酶阴性葡萄球菌均对替加环素、利奈唑胺完全不耐药。结论:ICU卒中相关性肺炎患者呼吸道病原菌分布广泛,以革兰阴性菌株为主,且多数细菌对抗菌药物具有较强的耐药性,临床应依据药敏试验指导抗菌药物用药。
Objective:To investigate distribution and drug sensitivity test results of pathogenic bacteria in respiratory tract in patients with stroke-associated pneumonia in ICU.Methods:196 patients with stroke-associated pneumonia admitted to the hospital from January 2019 to December 2020 were selected as the study subjects.The respiratory tract bacterial specimens were collected and cultured.The distribution characteristics and composition of pathogenic bacteria in the patients with stroke-associated pneumonia in ICU were analyzed.The drug resistance of gram negative and positive strains to different antibiotics was analyzed.Results:172 strains of pathogenic bacteria were isolated from the 196 patients with stroke-associated pneumonia in ICU,including 38 strains of Gram-positive bacteria(22.09%),118 strains of Gram-negative bacteria(68.60%)and 16 strains of fungi(9.30%).Gram-negative strains were mainly Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae;grampositive strains were mainly Coagulase negative staphylococcus and Staphylococcus aureus;fungi are mainly white Candida albicans.Among 118 strains of gram-negative bacteria,the resistance rates of Acinetobacter baumannii to Gentamicin,Ceftriaxone and Piperacillin were more than 80%;the resistance rates of Pseudomonas aeruginosa to Gentamicin,Ceftriaxone,Piperacillin and Ceftazidime were more than 60%;the resistance rates of Klebsiella pneumoniae to Gentamicin and Piperacillin were more than 90%;and the resistance rates of Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae to Imipenem and Meropenem were less than 20%.Among the 38 Gram-positive bacteria,the resistance rates of coagulase-negative Staphylococcus to Penicillin and Erythromycin were all above 80%;the resistance rates of Staphylococcus aureus to Penicillin,Erythromycin,Oxacillin and Ciprofloxacin were all above 80%;and Staphylococcus aureus and coagulase-negative Staphylococcus were completely not resistant to Tigecycline and Linezolid.Conclusions:The respiratory pathogens in the patients with stroke-associated pneumonia in ICU are widely distributed,mainly Gram-negative strains.Most bacteria have strong resistance to antibiotics.Therefore,the clinical use of antibiotics should be guided according to the drug sensitivity test.
作者
邬泽文
WU Zewen(Emergency Internal Medicine Department of Xin County People’s Hospital,Xinyang 465550 Henan,China)
出处
《中国民康医学》
2022年第23期19-22,共4页
Medical Journal of Chinese People’s Health
关键词
ICU卒中相关性肺炎
呼吸道
病原菌
细菌培养
药敏试验
抗菌药物
耐药性
Stroke-associated pneumonia in ICU
Respiratory tract
Pathogenic bacteria
Bacterial culture
Drug sensitivity test
Antibiotics
Drug resistance
