摘要
目的：了解神经内科患者下呼吸道感染病原体的特点及耐药性，为临床诊治患者和科学选药提供参考。方法选择2011年12月-2013年3月神经内科患者送检的痰标本，对其进行病原体检测和药敏分析，病原体分离与培养严格按照《全国临床检验操作规程》进行，菌株鉴定采用法国生物梅里埃公司VITEK-32全自动微生物分析仪进行，药敏试验采用CLSI推荐的K-B纸片法。结果神经内科患者送检的痰标本共检出病原体307株，其中真菌148株占48．21％，革兰阴性菌100株占32．57％，革兰阳性菌58株占18．89％，支原体属1株占0．33％；白色假丝酵母菌对氟胞嘧啶的耐药率为83．04％，革兰阴性菌对氨苄西林、头孢唑林的耐药率＞80．00％，革兰阳性菌对头孢西丁、头孢噻利、哌拉西林／他唑巴坦等耐药率＞80．00％，但对万古霉素敏感。结论神经内科患者下呼吸道感染以真菌感染为主，临床医师对中性粒细胞减少伴发热的脑卒中患者经广谱抗菌药物预防性治疗3～7d后，患者仍持续发热且原因不明者，应考虑真菌感染，并立即送检患者痰标本进行病原学鉴定和药敏监测，及时根据病原体和药敏结果合理选用抗菌药物。
OBJECTIVE To understand the characteristics and drug resistance of pathogens causing lower respiratory tract infections in neurology, so as to provide the reference for clinical diagnosis and treatment of patients and the scientific selection of medicine .METHODS Sputum samples were collected from the inpatients with lower respiratory tract infections in the neurology of our hospital from Dec .2011 to Mar .2013 .The detection of pathogens and the drug sensibility were conducted .The isolation and culture of pathogens was conducted in strict accordance with National Clinical Laboratory Procedures, strain identification was performed with VITEK-32 full-automatic microbial analyzer （Biomerieux, France）, and the drug sensibility test was performed with the K-B method recommended by CLSI .RESULTS A total of 307 strains of pathogens were isolated from the sputum samples, including 148 strains of fungi accounting for 48 .21%, 100 strains of gram-negative bacteria accounting for 32 .57%, 58 strains of gram-positive bacteria accounting for 18 .89% and 1 strain of mycoplasma accounting for 0 .33% .Candida albicans were resistant to flucytosine whose drug resistance rate reached to 83 .04% .The resistance of gram-negative bacteria to ampicillin, cefazolin was more than 80 .00% . The resistance of gram-positive bacteria to cefoxitin, cefoselis, and piperacillin/tazobactam was more than 80 .00%, but it was sensitive to vancomycin .CONCLUSION The main pathogens causing lower respiratory tract infection in neurology were fungi .For those neutropenic fever inpatients with stroke whose fever was persistent after broad-spectrum antimicrobial prophylactic treatment for 3 -7 days and with unknown causes for fever, clinicians should suspect fungal infection, and submit sputum samples immediately for pathogen identification and sensibility monitoring, and reasonably use antibiotics according to the pathogenic bacteria and drug sensitivity results .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第20期5016-5018,共3页
Chinese Journal of Nosocomiology
基金
湖北省教学科学"十二五"规划基金项目(2012B083)
关键词
神经内科
下呼吸道感染
病原体
耐药性
Neurology
Lower respiratory tract infection
Pathogen
Drug resistance
