老年卒中相关性肺炎发生多重耐药菌感染的危险因素及病原学分析

Risk factors and etiology of stroke associated pneumonia in elderly patients with multiple drug-resistant bacterial infections

目的探讨老年卒中相关性肺炎(SAP)患者发生多重耐药菌感染的危险因素、多重耐药菌的分布及耐药情况。方法回顾性分析我院神经内科2007年6月至2011年6月的老年SAP患者的临床资料。(1)危险因素分析:通过χ2检验分别比较各个因素组SAP发生多重耐药菌感染的发病率的差异,经单因素分析后选取P<0.05的因素进行多因素回归分析。(2)病原学调查:多重耐药菌的病原菌分布、常见多重耐药菌菌株的耐药情况。结果单因素分析显示,卒中类型、意识水平、SAP类型、入住病房、接受胃管、预防性应用抗生素等因素存在统计学差异(P<0.05),多因素回归分析显示,意识障碍、晚发性肺炎、入住ICU病房这3个因素有统计学意义(P值分别为0.001、0.001、0.038),是SAP发生多重耐药菌感染的危险因素;在154例患者中分离出182株细菌,其中多重耐药菌115株,在多重耐药菌株中排名前5位依次是:鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、溶血性葡萄球菌,金黄色葡萄球菌。结论意识障碍、晚发性肺炎、入住ICU病房是SAP发生多重耐药菌感染的危险因素;多重耐药菌所占比例较高,对多种抗生素呈广泛的不同程度的耐药。

Objective To discuss the risk factors, the distribution and drug resistance of multiple drug- resistant bacteria of stroke associated pneumonia （SAP） in elderly patients with multiple drug-resistant bacterial infections. Methods A retrospective study was designed to analyze the clinical data of elderly patients with SAP from June 2007 to June 2011. （1） Risk Factors： Comparison in incidence of SAP patients with multiple drug-resistant infection between different groups by chi square test. Multivariable regression analysis was used after univariate analysis. （2）Etiological investigation： distribution of multiple drug-resistant bacteria, drug resistance of common multiple drug-resistant bacteria. Results Univariate analysis indicated that there was statistical difference between the two groups divided by type of stroke level of consciousness SAP type ward type receiving stomach tube and prophylactic antibiotics. Multivariable regression analysis indicated that there was statistical significant in disturbance of consciousness late-onset pneumonia and ICU ward. There are182 strains in 154 patients, including 115 multiple drug-resistant strains （P value were 0.001, 0.001, 0.038）. Among 38 multiple drug-resistant strains the first 5 strains were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Hemolytic staphylococcus, Staphylococcus aureus. Conclusion SAP patients with multiple drug-resistant bacterial infections is closed related to the following risk factors： disturbance of consciousness late-onset pneumonia and ICU ward. The prevalence of the multiple drug-resistant bacteria was high. These multiple drug-resistant strains were widely different degrees of resistance to many antibiotics.