重癥監(jiān)護(hù)病房腦卒中后肺炎患者多藥耐藥菌感染病原學(xué)檢測(cè)分析

范路梅 魏紅 謝小紅

[摘要]目的 分析重癥監(jiān)護(hù)病房（ICU）腦卒中后肺炎患者多藥耐藥菌感染的病原學(xué)分布。方法 回顧性分析2014年6月～2018年6月我院ICU收治的190例腦卒中后肺炎患者的臨床資料，對(duì)其進(jìn)行多藥耐藥菌感染病原學(xué)分布及耐藥性分析。結(jié)果 190例ICU腦卒中后肺炎患者中，共有110例并發(fā)多藥耐藥菌感染，感染率為57.89%。分離培養(yǎng)出多藥耐藥菌病原200株，其中革蘭陰性菌148株，占74.0%，革蘭陽(yáng)性菌49株，占24.50%，真菌3株，占1.50%。革蘭陰性桿菌中，銅綠假單胞菌對(duì)氨芐西林、頭孢曲松的耐藥率較高;肺炎克雷伯菌對(duì)慶大霉素的耐藥率較高;鮑氏不動(dòng)桿菌對(duì)氨芐西林、氨曲南、頭孢曲松的耐藥率較高。革蘭陽(yáng)性桿菌中，金黃色葡糖球菌對(duì)青霉素、紅霉素、環(huán)丙沙星、四環(huán)素、氨芐西林及慶大霉素的耐藥率較高;溶血葡糖球菌對(duì)青霉素、紅霉素、環(huán)丙沙星、氨芐西林及慶大霉素的耐藥率較高;表皮葡糖球菌對(duì)四環(huán)素、紅霉素的耐藥率較高。結(jié)論 多藥耐藥菌所占比例較高，對(duì)多重抗生素呈廣泛的不同程度的耐藥，臨床上應(yīng)科學(xué)選擇耐藥率抗菌藥物進(jìn)行治療。

[關(guān)鍵詞]腦卒中;肺炎;多藥耐藥菌;病原學(xué)

[中圖分類號(hào)] R563? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2019）7（c）-0101-04

[Abstract] Objective To analyze the pathogenic distribution of multidrug resistant bacterial infections in patients with post-stroke pneumonia in intensive care unit （ICU）. Methods The clinical data of 190 patients with post-stroke pneumonia admitted to ICU of our hospital from June 2014 to June 2018 were were retrospectively analyzed. The pathogenic distribution and drug resistance of multi-drug resistant bacterial infections were analyzed. Results Among 190 ICU patients with post-stroke pneumonia， a total of 110 patients with post-stroke pneumonia in ICU were infected with multidrug-resistant bacteria， the infection rate was 57.89%. Two hundred strains of multidrug-resistant bacteria were isolated and cultured， including 148 strains of gram-negative bacteria， accounted for 74.0%， 49 strains of gram-positive bacteria， accounted for 24.50%， and 3 strains of fungi， accounted for 1.50%. Among gram-negative bacilli， the resistence rate of pseudomonas aeruginosa was higher to Ampicillin and Ceftriaxone; the resistence rate of klebsiella pneumoniae was higher to Gentamicin， and the resistence rate of acinetobacter bauxii was higher to Ampicillin， Amtraline and Ceftriaxone. Among gram-positive bacteria， the resistence rate of staphylococcus aureus aureus were higher to Penicillin， Erythromycin， Ciprofloxacin， Tetracycline， Ampicillin and Gentamicin， the resistence rate of hemolytic glucococcus was higher to Penicillin， Erythromycin， Ciprofloxacin， Ampicillin and Gentamicin， and the resistence rate of glucococcus epidermidis was higher to Tetracycline and Erythromycin. Conclusion Multidrug-resistant bacteria account for a high proportion and are widely resistant to multiple antibiotics in varying degrees. Sensitive antibiotics should be scientifically selected for clinical treatment.

[Key words] Stroke; Pneumonia; Multidrug resistant bacteria; Etiology