急性期卒中相关性肺炎的病原菌及其耐药性

目的了解急性期脑卒中患者肺部感染的病原菌构成及耐药情况，指导临床抗菌药物的使用。方法回顾性调查2008-2013年某三级甲等综合医院收治的卒中相关性肺炎（SAP）患者，分析其痰培养病原菌构成及药敏试验结果。结果共调查SAP患者98例，痰标本中共分离病原菌124株，其中革兰阴性（G-）菌75株（占60.48%），革兰阳性（G+）菌44株（占35.49%），真菌5株（占4.03%）。存在混合感染的患者21例（21.43%），治疗过程中出现细菌变更者23例（23.47%）。检出菌株数居前4位的依次为金黄色葡萄球菌（43株，占34.68%）、肺炎克雷伯菌（19株，占15.32%）、铜绿假单胞菌及鲍曼不动杆菌（各18株，各占14.52%）。肺炎克雷伯菌对常见抗菌药物的耐药率均＜32%，对头孢他啶、哌拉西林/他唑巴坦、亚胺培南、环丙沙星、左氧氟沙星、阿米卡星、妥布霉素均100%敏感。鲍曼不动杆菌及铜绿假单胞菌均呈现严重的多重耐药（MDR）现象，鲍曼不动杆菌对头孢他啶的耐药率＞80%。铜绿假单胞菌对亚胺培南的耐药率为33.33%。真菌中未检出耐药菌株。结论该院SAP患者的主要病原菌为金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌，且除肺炎克雷伯菌外，其余均耐药严重，临床医生应根据其分布特点及药敏情况合理选择抗菌药物。

Pathogens and antimicrobial resistance of pathogens causing acute stroke associated pneumonia

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing pneumonia in acute stroke patients, and guide clinical antimicrobial use.Methods Patients with stroke associated pneumonia(SAP) admitted to a tertiary first class hospital from 2008 to 2013 were investigated retrospectively, distribution and antimicrobial susceptibility testing results of pathogens from sputum were analyzed.ResultsA total of 98 patients with SAP were investigated, 124 stains were isolated from sputum specimens, 75 strains (60.48%) were gram negative bacteria, 44 (35.49%) were gram positive bacteria, and 5 (4.03%) were fungi. There were 21 cases of mixed infection (21.43%), bacterial alterations during treatment process existed among 23 cases（23.47%）.The top 4 isolated pathogens were Staphylococcus aureus（S. aureus,n=43，34.68%）, Klebsiella pneumoniae（K. pneumoniae, n=19，15.32%）, Pseudomonas aeruginosa（P. aeruginosa, n=18，14.52%）, and Acinetobacter baumannii（A. baumannii, n=18，14.52%）. Antimicrobial resistance rates of K. pneumoniae were all ＜32%，and susceptibility rates to ceftazidime, piperacillin /tazobactam, imipenem, ciprofloxacin, levofloxacin, amikacin, and tobramycin were all 100%. Both A.baumannii and P.aeruginosa showed severe multidrug resistance. Resistance rates of A.baumannii to ceftazidime was >80%, resistance rates of P.aeruginosa to imipenem was 33.33%. No resistant strains were detected among fungi.ConclusionThe main pathogens causing SAP in this hospital are S.aureus, K.pneumoniae, A.baumannii, and P.aeruginosa, except K.pneumoniae, the other strains are severely resistant to antimicrobial agents, clinicians should choose antimicrobial agents according to the distribution characteristics and antimicrobial susceptibility testing results.