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目的探讨急性脑血管病合并肺炎的病原学诊断及早期经验性抗感染治疗。方法 2010年10月至2011年12月经CT或MRI证实的急性脑血管病,并符合医院内获得性肺炎诊断标准的患者50例,男26例,女24例;年龄51～73(61±11)岁。均连续3次送检主动咳出的痰液或气管内抽吸物或纤维支气管镜毛刷采样标本。在HX-21全自动细菌培养及鉴定系统仪器下做细菌培养加药敏试验。结果痰送检总数50例,痰培养细菌检出29株,检出率为58.0%,以革兰阴性杆菌为主。29株中以铜绿假单孢菌构成占首位(37.9%),其次为金黄色葡萄球菌(20.6%),以下依次为大肠埃希菌、格高菲肠杆菌、产气肠杆菌、白色念珠菌。结论痰病原学诊断及药敏试验对合理的抗生素选择很重要,推荐首先使用β-内酰胺类和β-内酰胺酶抑制剂联合用药,重症患者首选碳青酶烯类药物进行经验性治疗,再依据病原菌检查结果降阶梯改用特异性的抗生素治疗。
Objective To investigate the etiological diagnosis and early empirical anti-infective therapy of acute cerebrovascular disease complicated with pneumonia. Methods Fifty patients (26 males and 24 females) aged 51-73 years (61 ± 11 years) with acute cerebrovascular disease confirmed by CT or MRI from October 2010 to December 2011 and meeting the diagnostic criteria of acquired pneumonia in hospital were enrolled. )year old. Consecutive three times the seizure of active sputum sputum or endotracheal intubation or fiberoptic bronchoscopy brush samples. In HX-21 automatic bacterial culture and identification system equipment bacterial culture plus drug sensitivity test. Results The total number of sputum examination in 50 cases, sputum culture bacteria detected 29 strains, the detection rate was 58.0%, mainly gram-negative bacilli. Of the 29 strains, Pseudomonas aeruginosa was the most common (37.9%), followed by Staphylococcus aureus (20.6%). The following were Escherichia coli, Enterobacter grueneniensis, Enterobacter aerogenes, Candida albicans . Conclusions Sputum etiology diagnosis and drug sensitivity test are very important for rational antibiotic selection. It is recommended to combine β-lactam and β-lactamase inhibitors first, and empiric treatment should be given to patients with severe carbapenem. Based on the results of pathogen examination and then step down the ladder to use specific antibiotic treatment.