脑卒中患者医院获得性肺炎的病原学及耐药性分析

目的探讨脑卒中患者医院获得性肺炎（HAP）的病原菌分布特点及耐药性，为合理使用抗菌药物提供依据。方法对143例脑卒中合并HAP患者的痰培养及药敏结果进行回顾性分析。结果共分离出病原菌168株，其中革兰阴性菌占61．90％（104／168），主要为肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌等；革兰阳性菌占25．60％（43／168），以金黄色葡萄球菌最多见，其次为凝固酶阴性葡萄球菌和粪肠球菌；真菌占12．50％（21／168），主要为白色假丝酵母菌。致病菌对常用抗菌药物都产生了不同程度的耐药性。结论脑卒中患者HAP的主要病原菌是革兰阴性菌，耐药率普遍较高，应根据病原学分析，合理应用抗菌药物。

Pathogens and drug resistance analysis in stroke patients with hospital-acquired pneumonia

Objective To analyze the distribution and drug resistance of pathogens causing hospital-acquired pneumonia （HAP） in stroke patients, and provide references for proper clinical application of antibiotics. Methods A retrospective investigation was performed to analyze the pathogens and the drug resistance of 143 stroke patients with HAP. Results Among 168 strains of isolated pathogens, the Gram-negative bacteria accounted for 61.90% （104/168）. including KlebsieUa pneumoniae , Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii,Enterobacter cloacae and so on. Gram-positive bacteria accounted for 25.60% （43/168）. Staphylococcus aureus ranked the first,followed by Coagulase negative staphylococcus and Enterococcusfaecalis. Fungi accounted for 12.50%（21/168）,mainly including Candida albicans. They had varying degrees of resistance to commonly used antibiotics. Conclusions Gramnegative bacteria is predominant in stroke patients with HAP. Drug resistance is very serious, and the antibiotics should be selected in clinic according to the result of drug susceptibility test.