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目的探讨脑卒中并发肺部感染患者的病原菌分布以及对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法收集2011年10月-2013年9月收治的436例脑卒中患者临床资料,对其中发生肺部感染患者的病原菌分布及其对抗菌药物的耐药率进行回顾性分析,研究数据采用SPSS13.0软件进行统计。结果 436例脑卒中患者并发肺部感染34例,感染率7.8%;34例卒中后肺部感染患者痰培养阳性29例,阳性率85.0%,共分离出病原菌70株,其中革兰阴性菌52株占74.3%、革兰阳性菌12株占17.1%、真菌6株占8.6%;革兰阴性菌中肺炎克雷伯菌对氨苄西林及头孢呋辛的耐药率较高,分别为100.0%及81.0%,铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢曲松的耐药率均达100.0%;革兰阳性菌中金黄色葡萄球菌对青霉素的耐药率为100.0%;对呋喃妥因、磺胺甲噁唑/甲氧苄啶、利奈唑胺、替加环素及万古霉素耐药率均为0;表皮葡萄球菌对苯唑西林、磺胺甲噁唑/甲氧苄啶、利福平以及四环素等耐药率均达100.0%。结论脑卒中患者并发肺部感染的病原菌以革兰阴性菌为主,临床应结合药敏试验合理使用抗菌药物,以期达到最佳的治疗效果。
Objective To investigate the distribution of pathogenic bacteria in patients with stroke complicated with pulmonary infection and the drug resistance to antibacterials, so as to provide basis for the rational use of antibacterials in clinic. Methods The clinical data of 436 stroke patients who were admitted to our hospital from October 2011 to September 2013 were retrospectively analyzed. The distribution of pathogens and the rate of resistance to antibiotics in patients with pulmonary infection were retrospectively analyzed. The data were analyzed by SPSS13. 0 software for statistics. Results Among the 436 stroke patients, 34 cases were complicated with pulmonary infection, the infection rate was 7.8%. Thirty-four sputum cultures were obtained from 34 patients with post-stroke pulmonary infection, the positive rate was 85.0%. 70 pathogens were isolated, of which Gram-negative bacteria Strains accounted for 74.3%, gram-positive bacteria 12 strains accounted for 17.1%, fungi 6 strains accounted for 8.6%; Gram-negative bacteria Klebsiella pneumoniae ampicillin and cefuroxime resistance rates were higher (100.0% And 81.0% respectively. The resistance rate of Pseudomonas aeruginosa to ampicillin, ampicillin / sulbactam, cefazolin and ceftriaxone reached 100.0%. The resistance of S. aureus to penicillin in Gram-positive bacteria The rates of resistance to nitrofurantoin, sulfamethoxazole / trimethoprim, linezolid, tigecycline and vancomycin were all 0; Staphylococcus epidermidis was resistant to oxacillin, sulfamethoxazole / Trimethoprim, rifampicin and tetracycline resistance rate reached 100.0%. Conclusions Gram-negative bacteria are the main pathogenic bacteria of pulmonary infection in stroke patients. Antibiotic drugs should be used in combination with susceptibility testing in order to achieve the best therapeutic effect.