脑血管病住院患者呼吸道感染病原菌分布及耐药性分析
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摘要
目的了解2012年-2016年本院脑血管病住院患者呼吸道感染病原菌特点及耐药分析,为临床治疗提供指导。方法对2012年-2016年脑血管病住院536例患者痰培养检出的733株病原菌进行统计分析。结果共分离出的733株病原菌中革兰阴性杆菌638株(87.2%),革兰阳性球菌94株(12.8%)。肺炎克雷伯杆菌(26.7%)、鲍曼不动杆菌(11.2%)、铜绿假单胞菌(11.1%)、大肠埃希菌(8.9%)、金黄色葡萄球菌(11.1%)为主要致病菌。革兰阴性菌对氨苄西林、头孢唑林、头孢曲松等耐药率较高,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南等敏感性较高。金黄色葡萄球菌对青霉素G、克林霉素、红霉素等耐药率高,对利奈唑胺、万古霉素、利福平等敏感性较高。耐碳青霉烯类抗生素的大肠埃希菌检出率从2014年起开始逐年增高至10%以上。结论全面系统监测脑血管病住院患者呼吸道感染及其细菌耐药动态,对临床合理使用抗菌药物有重要的参考意义。
Objective To investigate the characteristics of pathogenic bacteria and drug resistance of respiratory tract infection in patients with cerebrovascular disease in our hospital during 2012-2016,so as to provide guidance for clinical treatment.Methods To statistically analyze the 733 pathogenic bacteria isolates from sputum culture from 536 cerebral vascular patients during 2012-2016. Results 733 pathogenic bacteria isolates were collected,of which 638 isolates were gram-negative bacilli( 87. 2%),94 isolates were gram-positive cocci( 12. 8%). Klebsiella pneumoniae( 26. 7%),Bauman Acinetobacter( 11. 2%),Pseudomonas aeruginosa( 11. 1%),Escherichia coli( 8. 9%),Staphylococcus aureus( 11. 1%) were the 5 main pathogens.Gram-negative bacteria showed higher resistance to ampicillin,cefazolin and ceftriaxone,and were more sensitive to cefoperazone/sulbactam,piperacillin/tazobactam and imipenem. Staphylococcus aureus showed high resistance to penicillin G,clindamycin and erythromycin,and was more sensitive to linazolamine,vancomycin and rifampicin. Resistance rates of Escherichia coli to carbapenem were increasing quickly to 10% after 2014. Conclusion Comprehensive monitoring of respiratory tract infection and bacterial resistance in patients with cerebrovascular disease had important reference for clinical rational use of antimicrobial drugs.
Objective To investigate the characteristics of pathogenic bacteria and drug resistance of respiratory tract infection in patients with cerebrovascular disease in our hospital during 2012-2016,so as to provide guidance for clinical treatment.Methods To statistically analyze the 733 pathogenic bacteria isolates from sputum culture from 536 cerebral vascular patients during 2012-2016. Results 733 pathogenic bacteria isolates were collected,of which 638 isolates were gram-negative bacilli( 87. 2%),94 isolates were gram-positive cocci( 12. 8%). Klebsiella pneumoniae( 26. 7%),Bauman Acinetobacter( 11. 2%),Pseudomonas aeruginosa( 11. 1%),Escherichia coli( 8. 9%),Staphylococcus aureus( 11. 1%) were the 5 main pathogens.Gram-negative bacteria showed higher resistance to ampicillin,cefazolin and ceftriaxone,and were more sensitive to cefoperazone/sulbactam,piperacillin/tazobactam and imipenem. Staphylococcus aureus showed high resistance to penicillin G,clindamycin and erythromycin,and was more sensitive to linazolamine,vancomycin and rifampicin. Resistance rates of Escherichia coli to carbapenem were increasing quickly to 10% after 2014. Conclusion Comprehensive monitoring of respiratory tract infection and bacterial resistance in patients with cerebrovascular disease had important reference for clinical rational use of antimicrobial drugs.
引文
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[11]常燕子,裘莉佩,崔裕山,等.宁波地区社区获得性金黄色葡萄球菌重症感染危险因素及菌株药物敏感性分析[J].中华临床感染病杂志,2015,8(3):248-252.
[12]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[13]陈燕萍,田锦勇,段畅,等.神经内科医院感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(22):5106-5108.
[14]姜雪锦,孙吉花,邢敏,等.综合医院感染多药耐药菌特点及直接经济损失分析[J].中华医院感染学杂志,2016,26(24):5727-5729.
[15]李传杰,陶建萍,李皇,等.实验室监测多药耐药菌及PDCA预防控制医院感染成效分析[J].中华医院感染学杂志,2015,25(3):589-591.
[2]韩玉梁,王凯,严小艳,等.神经内科老年患者医院感染目标监测及危险因素分析[J].中华保健医学杂志,2016,18(1):7-9.
[3]刘娟,汪志云,张坚磊,等.神经内科住院患者医院感染危险因素分析[J].中华医院感染学杂志,2016,26(1):209-210.
[4]邵宜波,马红秋,都鹏飞.神经内科住院患者医院感染的临床分析[J].中华医院感染学杂志,2008,18(1):49-50.
[5]孙明丽,鲁大云,周芳,等.神经内科医院感染病原菌感染特点与多药耐药菌感染研究[J].中华医院感染学杂志,2017,27(5):1054-1057.
[6]常燕子,李巧云,裘莉佩,等.社区获得性泌尿系感染大肠埃希菌的耐药性及β-内酰胺酶基因分析[J].中国卫生检验杂志,2010,20(6):1319-1321.
[7]费红军,常燕子,岑叶平,等.多药耐药鲍氏不动杆菌耐药性研究[J].中华医院感染学杂志,2010,20(24):3856-3859.
[8]于洋,马莉莉,柴丽,等.神经内科医院感染危险因素及病原学分析[J].医学研究杂志,2015,44(9):111-115.
[9]李秀芝,魏剑芬,李立文,等.神经内科医院感染病原菌分布及流行特点[J].中国病原生物学杂志,2016,11(4):369-373.
[10]Osthoff M,Mcguinness SL,Wagen AZ,et al.Urinary tract infections due to extended-spectrum beta lactamase-producing gramnegative bacteria:identification of risk factors and outcome predictors in an Australian tertiary referral hospital[J].Int J Infect Dis,2015,34:79-83.
[11]常燕子,裘莉佩,崔裕山,等.宁波地区社区获得性金黄色葡萄球菌重症感染危险因素及菌株药物敏感性分析[J].中华临床感染病杂志,2015,8(3):248-252.
[12]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[13]陈燕萍,田锦勇,段畅,等.神经内科医院感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(22):5106-5108.
[14]姜雪锦,孙吉花,邢敏,等.综合医院感染多药耐药菌特点及直接经济损失分析[J].中华医院感染学杂志,2016,26(24):5727-5729.
[15]李传杰,陶建萍,李皇,等.实验室监测多药耐药菌及PDCA预防控制医院感染成效分析[J].中华医院感染学杂志,2015,25(3):589-591.