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目的探讨急性脑梗死患者肺部感染发生率及肺部感染病原菌分布与耐药性,为临床诊治提供依据。方法回顾性分析医院2009年1月-2014年6月收治的1 462例急性脑梗死患者临床资料,调查分析肺部感染发生率,了解其感染病原菌种类及其耐药性,调查数据采用Excel软件进行处理,采用Whonet 5.4软件进行药敏统计分析。结果 1 462例急性脑梗死患者发生肺部感染82例,感染率为5.6%;共分离出病原菌107株,革兰阴性菌69株占64.5%,其中以肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主,分别占19.6%、13.1%和9.3%,革兰阳性菌29株占27.1%,主要以肺炎链球菌和金黄色葡萄球菌为主,分别占11.2%和9.3%,真菌9株占8.4%,其中白色假丝酵母菌占5.6%;主要革兰阴性菌对美罗培南和亚胺培南的耐药率较低,为0~4.8%;主要革兰阳性菌对万古霉素、亚胺培南和利奈唑胺的耐药率较低,为0~16.7%;真菌对氟康唑、伏立康唑和酮康唑耐药率较低,为0~20.0%。结论急性脑梗死患者肺部感染发生率较高,临床应积极采取预防治疗措施,减少感染的发生;若已发生感染,应参考药敏试验结果选用适宜的抗菌药物,以提高临床治疗效果。
Objective To investigate the incidence of pulmonary infection and pathogenic bacteria distribution and drug resistance in patients with acute cerebral infarction and provide the basis for clinical diagnosis and treatment. Methods The clinical data of 1 462 patients with acute cerebral infarction admitted from January 2009 to June 2014 in our hospital were retrospectively analyzed. The incidence of pulmonary infection was investigated, the types of pathogens and drug resistance were analyzed. The survey data were analyzed by Excel software For processing, the use of Whonet 5.4 software for drug susceptibility statistical analysis. RESULTS: Of the 462 patients with acute cerebral infarction, 82 cases of pulmonary infection occurred and the infection rate was 5.6%. A total of 107 pathogenic bacteria were isolated and 69 strains of gram-negative bacteria accounted for 64.5% of them, of which Klebsiella pneumoniae, Which accounted for 19.6%, 13.1% and 9.3% respectively, 29 strains of Gram-positive bacteria accounted for 27.1%, mainly Streptococcus pneumoniae and Staphylococcus aureus, accounting for 11.2% and 9.3% 9 strains of fungi accounted for 8.4%, of which Candida albicans accounted for 5.6%. The major gram-negative bacteria had a low resistance rate to meropenem and imipenem, ranging from 0 to 4.8%. The majority of Gram-positive bacteria The resistance rate of vancomycin, imipenem and linezolid was relatively low, ranging from 0 to 16.7%. The fungal resistance rates to fluconazole, voriconazole and ketoconazole were relatively low, ranging from 0 to 20.0%. Conclusions The incidence of pulmonary infection in patients with acute cerebral infarction is high. Preventive and curative measures should be actively taken to reduce the incidence of infection. If infection has occurred, appropriate antimicrobial agents should be selected according to the drug susceptibility test results to improve the clinical effect.