摘要
目的:探讨卒中相关性肺炎(SAP)的病原学特点及耐药性,为临床合理使用抗菌药物提供参考依据。方法:选取SAP病人161例,分析痰培养资料。并按照SAP病人脑卒中类型(出血性脑卒中和缺血性脑卒中),治疗过程中是否进行机械通气分类,分别比较其病原菌检出率,分析药物敏感试验结果。结果:161例SAP病人中,共检出细菌176株,病原菌以G-菌为主(70.45%),其次为G+菌(7.39%)和真菌(22.16%)。G-菌以肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌为主,检出产超广谱β-内酰胺酶菌26株,其中大肠埃希菌10株,肺炎克雷伯菌16株;G+菌以金黄色葡萄球菌为主,未检出耐甲氧西林葡萄球菌;真菌以白色念珠菌为主。药敏试验结果显示,G-菌对丁胺卡那霉素、哌拉西林他唑巴坦较敏感,G+菌对万古霉素、利奈唑胺较敏感。161例SAP中,出血性卒中98例,缺血性卒中63例;行机械通气100例,未行机械通气61例;出血性卒中和缺血性卒中、是否进行机械通气病人的病原菌构成差异均有统计学意义(P<0.01和P<0.05)。结论:SAP的致病菌以G-菌为主,且真菌及伴真菌的混合感染逐渐递增。不同卒中类型和机械通气影响SAP病原菌构成,临床上应根据病人的痰培养病原学特点合理应用抗菌药物。
Objective:To investigate the etiology characteristics and drug resistance of stroke associated pneumonia(SAP)for providing the reference in antimicrobial agents rational use.Methods:The sputum culture data in 161 SAP patients were analyzed,the type of stroke was divided into the ischemic stroke and hemorrhagic stroke,and classified according to the mechanical ventilation.The detection rate of pathogen and drug sensitive test were analyzed.Results:Among 161 SAP patients,176 strains bacteria were detected,which included G--bacteria(70.45%),G+-bacteria(7.39%)and fungi(22.16%).The G--bacteria mainly included Klebsiella peneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa and E.coli.Twenty-six extended-spectyumβ-lactamase strains were detected,which included 10 strains of E.coli and 16 strains of K.pneumoniae.The G+-bacteria mainly included Staphylococcus aureus,and the methicillin-resistant staphylococcus was not detected.Fungus was mainly Canidia albicans.Drug susceptibility test results showed that the G--bacteria was more sensitive to amikacin and piperacillin-tazobactam,the G+-bacteria was more sensitive to vancomycin and linezolid.Among 161 SAP cases,the ischemic stroke in 63 cases and hemorrhagic stroke in 98 cases were identified.One hundred cases treated with mechanical ventilation and 61cases treated without mechanical ventilation were found.The difference of the pathogenic bacteria composition between ischemic stroke and hemorrhagic stroke patients was statistically significant(P<0.01 and P<0.05).Conclusions:The G--bacteria is mainly pathogenic bacteria of SAP,and the fungi infection and mixed infection with fungi increase gradually.Different type stroke and mechanical ventilation affect the the pathogenic bacteria composition of SAP,and the rational use of antimicrobial agents should be in accordance with the etiology characteristics of sputum culture.
作者
廖泳
吴晓飞
LIAO Yong;WU Xiao-fei(Graduate School,Bengbu Medical College,Bengbu Anhui 233030;Emergency Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)
出处
《蚌埠医学院学报》
CAS
2020年第2期219-222,共4页
Journal of Bengbu Medical College
关键词
卒中相关性肺炎
病原学
耐药性
stroke associated pneumonia
etiology
drug resistance
