脑出血肺部感染患者的病原菌分布与治疗效果研究
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摘要
目的探究脑出血患者肺部感染的病原菌分布与治疗效果,为临床治疗提供参考依据。方法回顾性分析2013年1月-2015年1月医院收治的100例脑出血肺部感染患者临床资料,对患者的病原菌分布、药敏试验和治疗后1、3、5、7、10d的生存率进行分析。结果 100例患者共分离出176株病原菌,其中革兰阴性菌86株占48.9%,以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主,革兰阳性菌24株占13.6%,以金黄色葡萄球菌和表皮葡萄球菌为主,真菌66株占37.5%,以白色假丝酵母菌为主;大肠埃希菌对妥布霉素和阿莫西林的耐药率均为100.0%;肺炎克雷伯菌对阿莫西林和替卡西林的耐药率均为100.0%;铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶的耐药率最高为87.5%;金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌对青霉素的耐药率均为100.0%,治疗7d后有65例患者预后良好。结论脑出血后肺部感染的主要病原菌为革兰阴性菌,且对多种抗菌药物均有较高的耐药性,应加强对病原菌耐药性的监测,根据药敏结果合理用药,提高脑出血后肺部感染患者的生存率。
OBJECTIVE To explore the distribution of pathogens causing pulmonary infections in patients with cerebral hemorrhage and observe the therapeutic effect so as to provide guidance for clinical treatment.METHODS The clinical data of 100 cerebral hemorrhage patients with pulmonary infections who were treated in the hospital from Jan 2013 to Jan 2015 were retrospectively analyzed.The distribution of pathogens,results of drug susceptibility testing,and survival rates after the treatment for 1,3,5,7,and 10 days were observed.RESULTS A total of 176 strains of pathogens were isolated from 100 patients,including 86(48.9%)strains of gram-negative bacteria,24(13.6%)strains of gram-positive bacteria,and 66(37.5%)strains of fungi;the Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa were dominant among the gram-negative bacteria;the Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of gram-positive bacteria;the Candida albicans was dominant among the fungi.The drug resistance rates of the E.coli to tobramycin and amoxicillin were100.00%;the drug resistance rates of the K.pneumoniaeto amoxicillin and ticarcillin were 100.0%;the drug resistance rate of the P.aeruginosato sulfamethoxazole-trimethoprim was 87.5%.The drug resistance rates of the S.aureus,S.epidermidis,and Staphylococcus haemolyticus to penicillin were 100.0%.Totally 65 patients achieved favorable prognosis after the treatment for 7days.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the pulmonary infections in the patients with cerebral hemorrhage and are highly resistant to multiple antibiotics.It is necessary to strengthen the surveillance of drug resistance of the pathogens and reasonably use antibiotics based on the results of the drug susceptibility testing so as to raise the survival rate of the cerebral hemorrhage patients with pulmonary infections.
OBJECTIVE To explore the distribution of pathogens causing pulmonary infections in patients with cerebral hemorrhage and observe the therapeutic effect so as to provide guidance for clinical treatment.METHODS The clinical data of 100 cerebral hemorrhage patients with pulmonary infections who were treated in the hospital from Jan 2013 to Jan 2015 were retrospectively analyzed.The distribution of pathogens,results of drug susceptibility testing,and survival rates after the treatment for 1,3,5,7,and 10 days were observed.RESULTS A total of 176 strains of pathogens were isolated from 100 patients,including 86(48.9%)strains of gram-negative bacteria,24(13.6%)strains of gram-positive bacteria,and 66(37.5%)strains of fungi;the Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa were dominant among the gram-negative bacteria;the Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of gram-positive bacteria;the Candida albicans was dominant among the fungi.The drug resistance rates of the E.coli to tobramycin and amoxicillin were100.00%;the drug resistance rates of the K.pneumoniaeto amoxicillin and ticarcillin were 100.0%;the drug resistance rate of the P.aeruginosato sulfamethoxazole-trimethoprim was 87.5%.The drug resistance rates of the S.aureus,S.epidermidis,and Staphylococcus haemolyticus to penicillin were 100.0%.Totally 65 patients achieved favorable prognosis after the treatment for 7days.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the pulmonary infections in the patients with cerebral hemorrhage and are highly resistant to multiple antibiotics.It is necessary to strengthen the surveillance of drug resistance of the pathogens and reasonably use antibiotics based on the results of the drug susceptibility testing so as to raise the survival rate of the cerebral hemorrhage patients with pulmonary infections.
引文
[1]Boyton RJ,Reynolds CJ,Quigley KJ,et al.Immune mechanisms and the impact of the disrupted lung microbiome in chronic bacterial lung infection and bronchiectasis[J].Clin Exp Immunol,2013,171(2):117-123.
[2]Ariza-Prota MA,Pando-Sandoval A,García-Clemente M,et al.Primary pulmonary botryomycosis:a bacterial lung infection mimicking lung cancer[J].Int J Tuberc Lung Dis,2013,17(7):992-994.
[3]夏海全,孙杰,姜昊荣,等.颅内血肿清除术后患者气管切开发生肺部感染相关因素分析[J].中华医院感染学杂志,2013,23(9):2102-2104.
[4]张秀英,陈禄芝,杨再良,等.脑出血患者肺部感染的危险因素分析[J].中华医院感染学杂志,2014,24(6):1416-1417.
[5]王雅萍,李立宏,高国栋,等.利奈唑胺治疗脑出血后耐甲氧西林金黄色葡萄球菌肺炎的疗效和安全性评价[J].中国药物与临床,2013,13(11):1462-1463.
[6]杨志鸣,尹忠民.高血压性脑出血患者术后并发肺部感染的病原菌检测及耐药性分析[J].临床肺科杂志,2013,18(7):1343-1345.
[7]林建虎,卢艳艳,陆川,等.脑出血术后患者并发肺部感染分析[J].中华医院感染学杂志,2013,23(9):2060-2061.
[8]甘燕玲,王新莉,徐伟莉,等.脑出血术后意识障碍患者肺部感染的病原菌分布[J].中华医院感染学杂志,2012,22(15):3252-3253.
[2]Ariza-Prota MA,Pando-Sandoval A,García-Clemente M,et al.Primary pulmonary botryomycosis:a bacterial lung infection mimicking lung cancer[J].Int J Tuberc Lung Dis,2013,17(7):992-994.
[3]夏海全,孙杰,姜昊荣,等.颅内血肿清除术后患者气管切开发生肺部感染相关因素分析[J].中华医院感染学杂志,2013,23(9):2102-2104.
[4]张秀英,陈禄芝,杨再良,等.脑出血患者肺部感染的危险因素分析[J].中华医院感染学杂志,2014,24(6):1416-1417.
[5]王雅萍,李立宏,高国栋,等.利奈唑胺治疗脑出血后耐甲氧西林金黄色葡萄球菌肺炎的疗效和安全性评价[J].中国药物与临床,2013,13(11):1462-1463.
[6]杨志鸣,尹忠民.高血压性脑出血患者术后并发肺部感染的病原菌检测及耐药性分析[J].临床肺科杂志,2013,18(7):1343-1345.
[7]林建虎,卢艳艳,陆川,等.脑出血术后患者并发肺部感染分析[J].中华医院感染学杂志,2013,23(9):2060-2061.
[8]甘燕玲,王新莉,徐伟莉,等.脑出血术后意识障碍患者肺部感染的病原菌分布[J].中华医院感染学杂志,2012,22(15):3252-3253.