老年急性脑卒中患者医院获得性肺炎的病原菌分布与耐药性监测

发布时间：2018-12-06 10:26

【摘要】：目的监测并分析老年急性脑卒中患者医院获得性肺炎(HAP)的病原菌分布及耐药性,为临床用药提供参考。方法选择医院2012年3月-2013年3月42例老年急性脑卒中合并HAP患者资料进行回顾性分析,采用ATB-Expression分析仪对培养的病原菌进行鉴定,药敏试验采用K-B纸片法。结果共培养出病原菌57株,其中革兰阴性菌36株占63.16%,前3位菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,分别占17.54%、14.04%、8.77%,革兰阳性菌18株占31.58%,前3位菌依次为金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌,分别占12.28%、8.77%、7.01%,真菌3株占5.26%,以白色假丝酵母菌和热带假丝酵母菌为主,分别占3.51%、1.75%;革兰阴性菌中肺炎克雷伯菌及其他病原菌对氨苄西林、左氧氟沙星、庆大霉素、头孢曲松、头孢噻肟、氨苄西林/舒巴坦等临床常用抗菌药物的耐药率均50.0%,对美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦较敏感;革兰阳性菌对青霉素、左氧氟沙星、克林霉素普遍耐药,未发现耐万古霉素的菌株。结论随着抗菌药物的广泛应用,老年急性脑卒中HAP患者的病原菌耐药率居高不下,加强治疗中各环节的感染控制,杜绝或降低医源性感染,做好消毒隔离,避免患者间交叉感染,是预防和控制医院感染的重要举措,同时应避免在同一病区长时间使用同一种抗菌药物,以控制耐药菌株的滋生。
[Abstract]:Objective to monitor and analyze the distribution and drug resistance of (HAP) in elderly patients with acute stroke. Methods from March 2012 to March 2013, 42 elderly patients with acute cerebral apoplexy complicated with HAP were retrospectively analyzed. The cultured pathogens were identified by ATB-Expression analyzer. The drug sensitivity test was performed by K-B disk method. Results A total of 57 strains of pathogenic bacteria were cultured, of which 36 strains were Gram-negative bacteria (63.16). The first three bacteria were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, respectively, which accounted for 17.544.044.04 and 8.77cm respectively, and the first three strains were Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa, respectively. There were 18 Gram-positive bacteria (31.58), and the first three were Staphylococcus aureus, Staphylococcus haemolyticus and Staphylococcus epidermidis, accounting for 12.288.777.01 and 5.26. Most of them were Candida albicans and Candida tropicalis, which accounted for 3.51% and 1.75% respectively. The resistance rates of Klebsiella pneumoniae and other pathogens to ampicillin, levofloxacin, gentamicin, ceftriaxone, cefotaxime, ampicillin / sulbactam were 50.0%. It was sensitive to meropenem, imipenem, piperacillin / tazobactam, cefoperazone / sulbactam; Gram-positive bacteria were generally resistant to penicillin, levofloxacin and clindamycin, but no vancomycin resistant strains were found. Conclusion with the extensive use of antimicrobial agents, the rate of drug resistance of the geriatric patients with acute cerebral apoplexy (HAP) remains high, and the infection control in all aspects of the treatment should be strengthened, the iatrogenic infection should be eliminated or reduced, and the disinfection and isolation should be done well. To avoid cross-infection among patients is an important measure to prevent and control nosocomial infection. At the same time, the use of the same antibiotics for a long time in the same ward should be avoided in order to control the breeding of drug-resistant strains.
【作者单位】：日照市人民医院护理部;
【基金】：日照市卫生局基金资助项目(SR-2010B-1023)
【分类号】：R446.5;R563.1

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