脑卒中并医院感染的细菌分布及耐药性分析

目的：了解引起脑卒中并医院感染细菌分布及耐药趋势，为临床治疗及感染的控制提供参考。方法：对本院2002年6月至2004年6月脑卒中并医院感染患者标本中分离出的致病菌并鉴定，按美国临床实验标准委员会1999年判断标准用纸片扩散法进行敏感试验。结果：从细菌的分布来看，脑卒中并医院感染部位主要以下呼吸道为主，共分离病原菌263株，革兰阳性菌73株，其中甲氧西林耐药株分别占金黄色葡萄球菌和凝固酶阴性．葡萄球菌的41．7％和44．0％；革兰阴性菌183株，主要以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、不动杆菌、嗜麦芽假单胞菌多见，其中产超广谱β内酰胺酶的革兰阴性杆菌占40．7％，监测中未发现万古霉素耐药的金黄色葡萄球菌，革兰阴性杆菌对亚胺培南耐药率最低，对氨苄西林、哌拉西林、环丙沙星耐药率较高。结论：脑卒中并医院感染的多重耐药问题相当严重，加强病原菌分布及耐药率监测，指导临床合理用药具有重大意义。

Characteristics and Resistancs Patterns Pathogens for Nosocomial Infection in Patients with Stroke

Objective: To determine the tendency of bacterial distribution and resistance of hospital infections and to provide the reference for the clinical treatment and infection control with strokes. Method: Bacteria were isolated and indenfied from JUN.2002 to JUN.2004,and bacteria`s drug susceptibility test was performed on strains using standard Kirby-Bauer method according with guidelines of NCCLS(1999).Result: According to the distributions of bacteria,lower respiratory tract was the most frequent infection site,Total of 263 straints pathogens were isolated, among them 73 strains were Gram-positive cocci.Meticillin resistant strains accounted for 41.7%and 44.0%of Staphylococcus aureus and CNS,respectively There were 183 strains Gram-negative bacilli.the most common pathogens of them were pseudomonas aeruginosa,Klebsiella pneumoniae, Escherichia coli, Acinetobacter,Stenotrophomonas .The ESBL producing strains accounted for 22.4% of Gram-negative bacilli .in our surveillance,there were no vancomycin resistant strains of S.aureus.The highest susceptible to Gram-negative bacilli is imipenem.Resistant rates of Gram-negative bacilli against ampicillin ,piperacillin,fluoroquinolines were higher.Conclusion: Multi-drug resistance of the nosocomial infection bacteria is a serious problem.It has a very important clinical value to inspect the bacterial spectrum and drug resistance.