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目的调查和分析卒中相关性医院获得性肺炎的病原菌种类、分离率及其对常见抗菌药物耐药情况,为临床经验性诊疗提供参考。方法收集宁波市第一医院2011年1月—2013年12月卒中相关性医院获得性肺炎病例209例为研究组,收集同期非卒中相关性医院获得性肺炎病例200例设为对照组,比较分析病原菌种类及其耐药性。计数数据以例数、百分率表示,采用χ2检验,检验水准α=0.05。结果研究组病原菌阳性率为64.59%(135/209),共分离出18种病原菌。研究组检出革兰氏阴性菌111株,占82.22%(111/135),比例高于对照组,差异有统计学意义(χ2=10.8333,P=0.001)。研究组革兰氏阴性菌以肠杆科细菌为首位,对含有超广谱β内酰胺酶抑制剂的复合抗菌药物有80%以上的敏感率;非发酵菌占次位,对头孢哌酮舒巴坦保持60%左右敏感性。研究组革兰氏阳性菌以金黄色葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球54.5%。2组肠杆科细菌产ESBLs阳性率比较差异无统计学意义(χ2=0.261,P=0.609),MRSA阳性率比较差异无统计学意义(χ2=0.094,P=0.760)。结论卒中相关性医院获得性肺炎病原菌种类较多,以肠杆科细菌为首位,非发酵菌为次位。耐药相对严重,含有超广谱β内酰胺酶抑制剂的复合抗菌药物可作为初始经验性治疗的首选药物。
Objective To investigate and analyze the types and isolation rates of pathogenic bacteria in hospital-acquired pneumonia and its resistance to common antimicrobial agents in stroke-related hospital, and to provide a reference for the clinical diagnosis and treatment. Methods A total of 209 hospital-acquired pneumonia cases from January 2011 to December 2013 were collected from the First Hospital of Ningbo City from January 2011 to December 2013. A total of 200 cases of non-stroke related hospital acquired pneumonia were collected as the control group. Pathogenic bacteria and their resistance. The count data is expressed as the number of cases and the percentage, using χ2 test, the test level α = 0.05. Results The positive rate of pathogens in study group was 64.59% (135/209), and 18 kinds of pathogens were isolated. 111 strains of Gram-negative bacteria were detected in the research group, accounting for 82.22% (111/135), the difference was statistically significant (χ2 = 10.8333, P = 0.001). Gram-negative bacteria in the research group, with Enterobacteriaceae as the first, had a sensitivity of more than 80% to the composite antibacterials containing extended-spectrum beta-lactamase inhibitors; non-fermenters accounted for the second place, cefoperazone Bartan maintain about 60% sensitivity. Gram-positive bacteria in the study group were Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 54.5% of Staphylococcus aureus. There was no significant difference in the positive rates of ESBLs between the two groups (χ2 = 0.261, P = 0.609). There was no significant difference in the positive rate of MRSA between the two groups (χ2 = 0.094, P = 0.760). Conclusions Stroke-related hospital-acquired pneumonia has more pathogens, with Enterobacteriaceae as the first place and non-fermentative bacteria as the second place. Drug resistance is relatively serious, with extended spectrum β-lactamase inhibitor composite antimicrobial drugs can be used as the initial empirical treatment of choice drugs.