重症监护病房卒中相关性肺炎的病原学特点及其药敏分析

Distribution and antibiotic sensitivity of pathogens isolated from stroke-associated pneumonia in intensive care unit

摘要:

目的 分析重症监护病房（ICU）卒中相关性肺炎（SAP）患者的病原学分布特点及抗菌药物的耐药情况，为临床治疗提供参考依据。方法 对2010年3月至2011年3月，收治在南京医科大学第一附属医院ICU的129例脑卒中患者痰标本培养及药敏结果进行回顾性分析。结果 129例卒中患者中64例发生SAP，SAP患者中41例痰培养阳性，检出率为64.06%，共检出病原菌69株，以革兰阴性菌为主，共46株（66.67%），主要为鲍曼不动杆菌23株（33.33%）；革兰阳性菌11株（15.94%），主要为金黄色葡萄球菌9株（13.04%）；真菌12株（17.40%），主要为白色假丝酵母菌4株（5.80%）和光滑假丝酵母菌4株（5.80%）。鲍曼不动杆菌为多药耐药菌，对头孢哌酮/舒巴坦的敏感率最高，为30.43%；铜绿假单胞菌对亚胺培南的耐药率最低，为16.67%；金黄色葡萄球菌对万古霉素、利奈唑胺及替考拉宁敏感；真菌对氟康唑、伊曲康唑、伏立康唑、卡泊芬净和两性霉素敏感。结论 ICU内SAP患者的主要致病菌为革兰阴性菌，耐药谱广，且耐药性强，应定期对SAP患者病原学分布和耐药性进行监测，合理应用抗生素，增加SAP患者的治愈率。

Abstract:

Objective To analyze the distribution, sensitivity and resistance pattern of pathogen isolated from patients with stroke-associated pneumonia (SAP) in ICU. Methods From March 2010 to March 2012, 129 patients with brain stroke who had been admitted to ICU of our hospital were enrolled in this study. Their sputum cultivation and drug sensitivity were retrospectively analyzed. Results Of all the 129 patients, 64 cases were found having SAP, among which 41 cases were positive for sputum cultivation, with a positivity rate of 64.06%. There were totally 69 strains of bacteria isolated. And 46 strains (66.67%) were Gram negative bacilli, dominantly with 23 strains of Acinetobacter baumannii (33.33%). Eleven strains (15.94%) were Gram positive cocci, mainly Methicillin resistant Staphylococcus aureus (9 strains, 13.04%). And the left 12 strains were fungi (17.40%), with 4 strains of Candida albicans (5.80%) and 4 strains of Candida glabrata (5.80%) covering the main part. Acinetobacter baumannii was drug resistant but especially sensitive to Cefoperazone/Sulbactam, with a rate of 30.43%. Pseudomonas aeruginosa was highly sensitive to Imipenem, with a rate of 88.33%. Methicillin resistant Staphylococcus aureus had a very high sensitivity to Vancomycin, Teicoplanin and Linezolid. The isolated fungi were sensitive to Fluconazol, Itraconazole, Voriconazole, Caspofungin, as well as Amphotericin. Conclusion The major pathogenic bacteria causing SAP in ICU are Gram negative, and resistant to a range of antibiotics, both widely and strongly. Regularly monitoring the distribution and drug resistance of pathogens, and rationally using antibiotics will certainly increase the cure rate of SAP.