2016—2019年安徽省某三级医院呼吸科与ICU卒中相关性肺炎病原菌分布及耐药性

目的 分析呼吸科与重症监护病房(ICU)卒中相关性肺炎(SAP)病原菌分布变迁、耐药性特点，为临床合理使用抗菌药物提供参考。方法 回顾性分析2016年1月至2019年6月呼吸科及ICU收治SAP患者病原菌及药敏结果，调查产超广谱β-内酰胺酶(ESBLs)及耐碳青霉烯类抗生素病原菌(CRO)比率。结果 呼吸科共检出病原菌41株，其中革兰阴性杆菌38株(92.69%)，革兰阳性球菌3株(7.32%)，依次为肺炎克雷伯菌16株(39.02%)，铜绿假单胞菌7株(17.07%)，鲍曼不动杆菌6株(14.63%)等。ICU共检出病原菌137株，革兰阴性杆菌128株(93.43%)，革兰阳性球菌9株(6.57%)，依次为肺炎克雷伯菌43株(31.39%)，鲍曼不动杆菌38株(27.74%)，铜绿假单胞菌16株(11.68%)等。呼吸科产ESBLs肺炎克雷伯菌、耐碳青霉烯肺炎克雷伯菌(CRKP)所占比率分别为50%和12.5%，而ICU分别为41.86%和2.33%；呼吸科耐碳青霉烯鲍曼不动杆菌(CRAB)、耐碳青霉烯铜绿假单胞菌(CRPA)所占比率分别为66.67%和28.57%，而ICU依次为97.37%和37.5%。ICU中鲍曼不动杆菌对于碳青霉烯类抗生素耐药性显著高于呼吸科 (P＜0.05)。结论 呼吸科与ICU收治SAP患者致病菌主要为革兰阴性杆菌，且对碳青霉烯类抗生素呈现一定耐药性。同时肺炎克雷伯菌已是最常见致病菌，甚至有CRKP被检出，应被重视。因此有必要加强监测SAP病原学及耐药性变迁，提供当地病原学资料，指导临床抗感染治疗。

The distribution and antimicrobial resistance of pathogens on stroke-associated pneumonia between the respiratory department and intensive care unit in a tertiary hospital in Anhui Province from 2016 to 2019

Objective To analyze the distribution and antimicrobial resistance of pathogens isolated from patients with stroke-associated pneumonia (SAP) between the respiratory department and intensive care unit(ICU) in our hospital, so as to provide references for rational use of antimicrobial agents. Methods A retrospective study was conducted by analyzing antimicrobial resistance of SAP between the respiratory department and ICU in our hospital from January 2016 to June 2019, and investigating the proportion of ESBLs-producing and carbapenem resistant organisms. Results A total of 41 clinical isolates were collected from the respiratory department. Among them, Gram-negative bacilli and Gram-positive cocci accounted for 92.67% and 7.32%. The three most isolated pathogens were Klebsiella pneumoniae (n=16, 39.02%), Pseudomonas aeruginosa (n=7, 17.07%), and Acinetobacter baumannii (n=6, 14.63%). Meanwhile, 137 clinical isolates were collected from ICU. Among them, Gram-negative bacilli and gram-positive cocci accounted for 93.43% and 6.57% respectively. The three most isolated pathogens were Klebsiella pneumoniae (n=43, 31.39%), Acinetobacter baumannii (n=38, 27.74%), and Pseudomonas aeruginosa (n=16, 11.68%). In the respiratory department, the proportion of ESBLs-producing Klebsiella pneumoniae and carbapenem resistant Klebsiella pneumoniae were 50% and 12.5%, while it was 41.86% and 2.33% respectively in ICU. In the respiratory department, the proportion of carbapenem resistant Acinetobacter baumannii and carbapenem resistant Pseudomonas aeruginosa were 66.67% and 28.57% respectively while it were 97.37% and 37.5% in ICU. The resistance of Acinetobacter baumannii to carbapenem in ICU was significantly higher than in respiratory department (P<0.05). Conclusion The major pathogens causing SAP in respiratory department and ICU were all Gram-negative bacilli. Most of them were resistant to carbapenem. Meanwhile, Klebsiella pneumoniae became the most frequent pathogen. Even CRKP was detected which should be paid close attention to. Therefore, it's necessary to enhance monitoring the distribution and antimicrobial resistance of SAP, to provide local etiological data for guiding clinical anti-infection treatment.