缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌分布及药敏分析
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摘要
目的:探讨缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌分布情况及其耐药性,为临床合理选择抗菌药物进行抗感染治疗提供参考。方法:选择2016年5月-2018年6月大连医科大学附属大连市中心医院神经内一科收治的182例缺血性脑卒中介入治疗后并发相关性肺炎患者,对患者痰标本进行细菌培养和鉴定,并对培养阳性的病原菌进行药物敏感性试验。结果:182例患者共送检痰标本并进行细菌培养276次,其中阳性检出199次,阳性检出率为72.10%,检出病原菌215株,革兰阴性杆菌153株,占71.16%,其中鲍氏不动杆菌是主要病原菌,占24.19%,其次为肺炎克雷伯菌,占20.93%;革兰阳性球菌62株,占28.84%,其中金黄色葡萄球菌为主要的病原菌,占11.16%,其次为溶血葡萄球菌,占7.91%。革兰阴性杆菌和革兰阳性球菌中的主要病原菌对抗菌药物的耐药性较严重,且存在多药耐药性的现象。结论:缺血性脑卒中患者介入治疗后并发相关性肺炎的病原菌以革兰阴性杆菌为主,且存在多药耐药率高的现象,临床应合理选取抗菌药物进行治疗。
Objective: To explore the distribution and drug resistance of pathogenic bacteria causing associated pneumonia in patients with cerebral ischemic stroke after interventional therapy, so as to provide reference for rational selection of antimicrobial drugs in anti-infective treatment in clinic. Methods: 182 patients with cerebral ischemic stroke complicated associated pneumonia after interventional therapy in First Department of Neurology in Dalian Central Hospital Affiliated to Dalian Medical University from May2016 June 2018 were selected. Bacterial culture and identification of sputum specimens were carried out, and drug sensitivity tests were carried out to culture positive pathogens. Results: A total of 276 cases of bacteria culture and sputum specimens were performed from182 patients. The positive rate was 199 times, and the positive detection rate was 72.10%. 215 strains of pathogenic bacteria were detected, there were 153 strains of gram-negative bacteria, accounting for 71.16%, in which acinetobacter baumannii was the main pathogenic bacteria, accounting for 24.19%, follorws by klebsiella pneumoniae, accounting for 20.93%. There were 62 strains of gram-positive bacteria, accounting for 28.84%, in which staphylococcus aureus was the main pathogenic bacteria, accounting for 11.16%,followed by staphylococcus haemolyticus, accounting for 7.91%. The main pathogenic bacteria of gram-negative bacteria and gram-positive bacteria are more resistant to antibacterials, and there is a phenomenon of multidrug resistance. Conclusion: The gram-negative bacteria are the main pathogenic bacteria causing associated pneumonia in patients with cerebral ischemic stroke after interventional therapy, and the pathogenic bacteria has a phenomenon of multiple drug resistance, so it is important to select the antibacterials rationally for the clinical treatment.
Objective: To explore the distribution and drug resistance of pathogenic bacteria causing associated pneumonia in patients with cerebral ischemic stroke after interventional therapy, so as to provide reference for rational selection of antimicrobial drugs in anti-infective treatment in clinic. Methods: 182 patients with cerebral ischemic stroke complicated associated pneumonia after interventional therapy in First Department of Neurology in Dalian Central Hospital Affiliated to Dalian Medical University from May2016 June 2018 were selected. Bacterial culture and identification of sputum specimens were carried out, and drug sensitivity tests were carried out to culture positive pathogens. Results: A total of 276 cases of bacteria culture and sputum specimens were performed from182 patients. The positive rate was 199 times, and the positive detection rate was 72.10%. 215 strains of pathogenic bacteria were detected, there were 153 strains of gram-negative bacteria, accounting for 71.16%, in which acinetobacter baumannii was the main pathogenic bacteria, accounting for 24.19%, follorws by klebsiella pneumoniae, accounting for 20.93%. There were 62 strains of gram-positive bacteria, accounting for 28.84%, in which staphylococcus aureus was the main pathogenic bacteria, accounting for 11.16%,followed by staphylococcus haemolyticus, accounting for 7.91%. The main pathogenic bacteria of gram-negative bacteria and gram-positive bacteria are more resistant to antibacterials, and there is a phenomenon of multidrug resistance. Conclusion: The gram-negative bacteria are the main pathogenic bacteria causing associated pneumonia in patients with cerebral ischemic stroke after interventional therapy, and the pathogenic bacteria has a phenomenon of multiple drug resistance, so it is important to select the antibacterials rationally for the clinical treatment.
引文
[1]Zhao P,Liu S,Zhong Z,et al.Age-and sex-related difference of lipid profile in patients with ischemic stroke in China[J].Medicine(Baltimore),2018,97(23):e10930
[2]Cho SK,Sohn J,Cho J,et al.Effect of Socioeconomic Status and Underlying Disease on the Association between Ambien Temperature and Ischemic Stroke[J].Yonsei Med J,2018,59(5)686-692
[3]涂雪松.缺血性脑卒中的流行病学研究[J].中国临床神经科学,201624(5):594-599
[4]Auboire L,Sennoga CA,Hyvelin JM,et al.Microbubbles combined with ultrasound therapy in ischemic stroke:A systematic review of in-vivo preclinical studies[J].PLoS One,2018,13(2):e0191788
[5]Knecht T,Story J,Liu J,et al.Adjunctive Therapy Approaches for Ischemic Stroke:Innovations to Expand Time Window of Treatment[J].Int J Mol Sci,2017,18(12):E2756
[6]Helmy TA,Abd-Elhady MA,Abdou M.Prediction of Ischemic Stroke-Associated Pneumonia:A Comparison between 3 Scores[J].JStroke Cerebrovasc Dis,2016,25(11):2756-2761
[7]Ribeiro PW,Cola PC,Gatto AR,et al.Relationship between Dysphagia,National Institutes of Health Stroke Scale Score,and Predictors of Pneumonia after Ischemic Stroke[J].J Stroke Cerebrovasc Dis,2015,24(9):2088-2094
[8]Hwong WY,Abdul Aziz Z,Sidek NN,et al.Prescription of secondary preventive drugs after ischemic stroke:results from the Malaysian National Stroke Registry[J].BMC Neurol,2017,17(1):203
[9]Campbell BCV,Mitchell PJ,Churilov L,et al.Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke[J].N Engl JMed,2018,378(17):1573-1582
[10]王姝梅,李海英,袁俊亮,等.卒中相关性肺炎与缺血性脑卒中严重程度及预后的关系研究[J].中国全科医学,2013,16(11):1203-1205
[11]Parikh NS,Merkler AE,Kummer BR,et al.Ischemic Stroke After Emergency Department Discharge for Symptoms of Transient Neurological Attack[J].Neurohospitalist,2018,8(3):135-140
[12]Pocovi N.Appraisal of Clinical Practice Guideline:2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke[J].J Physiother,2018,64(3):199
[13]贾春燕,池礼捷,牛瑞芳,等.自拟活血化瘀方对缺血性脑卒中患者生活质量的影响[J].现代生物医学进展,2016,16(36):7176-7178,7193
[14]Rajborirug K,Tumviriyakul H,Suwanno J.Effects of Stroke U nit Care in Acute Ischemic Stroke Patient Ineligible for Throm bolytic Treatment[J].J Med Assoc Thai,2017,100(4):410-417
[15]周腾飞,朱良付,李天晓,等.补救性支架植入治疗急性缺血性脑卒中13例[J].介入放射学杂志,2017,26(11):1028-1033
[16]Zhang R,Ji R,Pan Y,et al.External Validation of the Prestroke Independence,Sex,Age,National Institutes of Health Stroke Scale Score for Predicting Pneumonia After Stroke Using Data From the China National Stroke Registry[J].J Stroke Cerebrovasc Dis,2017,26(5):938-943
[17]Nascimento Alves P,Silva C,Baptista J,et al.Laterality of Pneumonia in Acute Stroke[J].Eur Neurol,2017,77(1-2):75-79
[18]胡科,任应国,徐明超,等.急性脑卒中患者肺部感染的病原菌特点与耐药性分析[J].中华医院感染学杂志,2016,26(1):68-70
[19]姚绍鑫,王健,李藏妥.脑卒中患者介入治疗后多药耐药菌感染的病原学分析[J].中华医院感染学杂志,2015,25(3):540-542
[20]Le Bouc R,Claren觭on F,Meseguer E,et al.Efficacy of Endovascular Therapy in Acute Ischemic Stroke Depends on Age and Clinical Severity[J].Stroke,2018,49(7):1686-1694
[21]刘慧珍,赵国伟,高钧.脑卒中合并肺部感染患者病原体分布及抗生素应用研究[J].中国预防医学杂志,2017,18(10):793-795
[22]Li P,Wang X,Wang W,et al.Comparison of the efficacies of three empirically-selected antibiotics for treating Acinetobacter baumannii pulmonary infection:experience from a teaching hospital in China[J]Int J Clin Pharmacol Ther,2017,55(7):588-593
[23]Douglas IS.Pulmonary infections in critical/intensive care-rapid diagnosis and optimizing antimicrobial usage[J].Curr Opin Pulm Med,2017,23(3):198-203
[24]Ferro BE,Srivastava S,Deshpande D,et al.Failure of the Amikacin Cefoxitin,and Clarithromycin Combination Regimen for Treating Pulmonary Mycobacterium abscessus Infection[J].Antimicrob Agents Chemother,2016,60(10):6374-6376
[25]韩小年,黄婧,贾晓涛,等.预防使用抗菌药物对脑卒中相关性肺炎有效性和安全性的Meta分析[J].中华神经医学杂志,2018,17(1)78-83
[26]Song JU,Park HK,Kang HK,et al.Proposed risk factors for infection with multidrug-resistant pathogens in hemodialysis patients hospitalized with pneumonia[J].BMC Infect Dis,2017,17(1):681
[27]Chin W,Zhong G,Pu Q,et al.A macromolecular approach to eradicate multidrug resistant bacterial infections while mitigating drug resistance onset[J].Nat Commun,2018,9(1):917
[28]Abdul-Aziz MH,Lipman J,Roberts JA.Antibiotic dosing for multidrug-resistant pathogen pneumonia[J].Curr Opin Infect Dis,2017,30(2):231-239
[29]Moon SM,Park HY,Kim SY,et al.Clinical Characteristics,Treatment Outcomes,and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease[J].Antimicrob Agents Chemother,2016,60(11):6758-6765
[30]温德良,李智博,温艺超,等.重症监护病房脑卒中相关性肺炎多重耐药菌感染的危险因素及病原学分析[J].实用医学杂志,2016,32(13):2178-2181
[2]Cho SK,Sohn J,Cho J,et al.Effect of Socioeconomic Status and Underlying Disease on the Association between Ambien Temperature and Ischemic Stroke[J].Yonsei Med J,2018,59(5)686-692
[3]涂雪松.缺血性脑卒中的流行病学研究[J].中国临床神经科学,201624(5):594-599
[4]Auboire L,Sennoga CA,Hyvelin JM,et al.Microbubbles combined with ultrasound therapy in ischemic stroke:A systematic review of in-vivo preclinical studies[J].PLoS One,2018,13(2):e0191788
[5]Knecht T,Story J,Liu J,et al.Adjunctive Therapy Approaches for Ischemic Stroke:Innovations to Expand Time Window of Treatment[J].Int J Mol Sci,2017,18(12):E2756
[6]Helmy TA,Abd-Elhady MA,Abdou M.Prediction of Ischemic Stroke-Associated Pneumonia:A Comparison between 3 Scores[J].JStroke Cerebrovasc Dis,2016,25(11):2756-2761
[7]Ribeiro PW,Cola PC,Gatto AR,et al.Relationship between Dysphagia,National Institutes of Health Stroke Scale Score,and Predictors of Pneumonia after Ischemic Stroke[J].J Stroke Cerebrovasc Dis,2015,24(9):2088-2094
[8]Hwong WY,Abdul Aziz Z,Sidek NN,et al.Prescription of secondary preventive drugs after ischemic stroke:results from the Malaysian National Stroke Registry[J].BMC Neurol,2017,17(1):203
[9]Campbell BCV,Mitchell PJ,Churilov L,et al.Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke[J].N Engl JMed,2018,378(17):1573-1582
[10]王姝梅,李海英,袁俊亮,等.卒中相关性肺炎与缺血性脑卒中严重程度及预后的关系研究[J].中国全科医学,2013,16(11):1203-1205
[11]Parikh NS,Merkler AE,Kummer BR,et al.Ischemic Stroke After Emergency Department Discharge for Symptoms of Transient Neurological Attack[J].Neurohospitalist,2018,8(3):135-140
[12]Pocovi N.Appraisal of Clinical Practice Guideline:2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke[J].J Physiother,2018,64(3):199
[13]贾春燕,池礼捷,牛瑞芳,等.自拟活血化瘀方对缺血性脑卒中患者生活质量的影响[J].现代生物医学进展,2016,16(36):7176-7178,7193
[14]Rajborirug K,Tumviriyakul H,Suwanno J.Effects of Stroke U nit Care in Acute Ischemic Stroke Patient Ineligible for Throm bolytic Treatment[J].J Med Assoc Thai,2017,100(4):410-417
[15]周腾飞,朱良付,李天晓,等.补救性支架植入治疗急性缺血性脑卒中13例[J].介入放射学杂志,2017,26(11):1028-1033
[16]Zhang R,Ji R,Pan Y,et al.External Validation of the Prestroke Independence,Sex,Age,National Institutes of Health Stroke Scale Score for Predicting Pneumonia After Stroke Using Data From the China National Stroke Registry[J].J Stroke Cerebrovasc Dis,2017,26(5):938-943
[17]Nascimento Alves P,Silva C,Baptista J,et al.Laterality of Pneumonia in Acute Stroke[J].Eur Neurol,2017,77(1-2):75-79
[18]胡科,任应国,徐明超,等.急性脑卒中患者肺部感染的病原菌特点与耐药性分析[J].中华医院感染学杂志,2016,26(1):68-70
[19]姚绍鑫,王健,李藏妥.脑卒中患者介入治疗后多药耐药菌感染的病原学分析[J].中华医院感染学杂志,2015,25(3):540-542
[20]Le Bouc R,Claren觭on F,Meseguer E,et al.Efficacy of Endovascular Therapy in Acute Ischemic Stroke Depends on Age and Clinical Severity[J].Stroke,2018,49(7):1686-1694
[21]刘慧珍,赵国伟,高钧.脑卒中合并肺部感染患者病原体分布及抗生素应用研究[J].中国预防医学杂志,2017,18(10):793-795
[22]Li P,Wang X,Wang W,et al.Comparison of the efficacies of three empirically-selected antibiotics for treating Acinetobacter baumannii pulmonary infection:experience from a teaching hospital in China[J]Int J Clin Pharmacol Ther,2017,55(7):588-593
[23]Douglas IS.Pulmonary infections in critical/intensive care-rapid diagnosis and optimizing antimicrobial usage[J].Curr Opin Pulm Med,2017,23(3):198-203
[24]Ferro BE,Srivastava S,Deshpande D,et al.Failure of the Amikacin Cefoxitin,and Clarithromycin Combination Regimen for Treating Pulmonary Mycobacterium abscessus Infection[J].Antimicrob Agents Chemother,2016,60(10):6374-6376
[25]韩小年,黄婧,贾晓涛,等.预防使用抗菌药物对脑卒中相关性肺炎有效性和安全性的Meta分析[J].中华神经医学杂志,2018,17(1)78-83
[26]Song JU,Park HK,Kang HK,et al.Proposed risk factors for infection with multidrug-resistant pathogens in hemodialysis patients hospitalized with pneumonia[J].BMC Infect Dis,2017,17(1):681
[27]Chin W,Zhong G,Pu Q,et al.A macromolecular approach to eradicate multidrug resistant bacterial infections while mitigating drug resistance onset[J].Nat Commun,2018,9(1):917
[28]Abdul-Aziz MH,Lipman J,Roberts JA.Antibiotic dosing for multidrug-resistant pathogen pneumonia[J].Curr Opin Infect Dis,2017,30(2):231-239
[29]Moon SM,Park HY,Kim SY,et al.Clinical Characteristics,Treatment Outcomes,and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease[J].Antimicrob Agents Chemother,2016,60(11):6758-6765
[30]温德良,李智博,温艺超,等.重症监护病房脑卒中相关性肺炎多重耐药菌感染的危险因素及病原学分析[J].实用医学杂志,2016,32(13):2178-2181
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