老年卒中相关性肺炎多药耐药菌感染的危险因素及病原学分析

Pneumonia in elderly stroke multidrug-resistant infections and etiological analysis of risk factors

目的对老年卒中相关性肺炎(SAP)发生多药耐药菌(MDR)感染的危险因素及病原学进行分析,为MDR感染的预防提供参考。方法选择2009年7月-2013年5月神经内科老年脑卒中患者540例,其中SAP患者138例,对其临床资料进行回顾性分析,统计老年SAP患者发生MDR感染例数,并对发生MDR感染的危险因素进行单因素分析,同时进行病原学分析,采用SPSS19.0统计软件对数据进行处理。结果 138例SAP患者中有71例发生MDR感染,感染率为51.4%;MDR感染与脑卒中类型、患者意识水平、入院季节、病房级别和预防性使用抗菌药物相关,差异有统计学意义(P<0.05);与患者性别、年龄、糖尿病史、脑卒中史、蛋白水平、语言功能和卒中部位无关;MDR感染患者共分离出156株病原菌,其中革兰阴性菌115株占73.7%,革兰阳性菌41株占26.3%。结论脑卒中类型、患者意识水平、SAP分类、病房级别和预防性使用抗菌药物等因素,是老年SAP患者发生MDR感染的危险因素,且病原菌以革兰阴性菌为主,这对往后临床预防MDR的发生具有指导价值。

OBJECTIVE To analyze the risk factors and etiology of multidrug resistant infections in elderly stroke associated pneumonia （SAP） ,so as to provide reference for MDR infection prevention .METHODS A total of 540 elderly patients with stroke in neurology department from Jul .2009 to May 2013 in our hospital were selected including 138 patients with SAP .Their clinical data was retrospectively analyzed to calculate MDR infection case in elderly patients with SAP and univariate analysis were taken for risk factors of MDR infections ,meanwhile etiology analysis was carried out .The data were analyzed by SPSS19 .0 statistical software .RESULTS There were 138 patients with SAP ,of which a total of 71 patients had MDR infections ,the rate was 51 .4% .MDR infection had close relationship with stroke types ,levels of consciousness in patients ,hospitalized seasons ,ward levels ,and prophylactic use of antibiotic-associated and the difference was significant （ P〈 0 .05 ）;and had nothing with gender ,age ,history of diabetes ,history of stroke ,protein levels ,language function and stroke positions .A total of 156 strains of bacteria were isolated in 71 cases of MDR-infected patients ,including 115 gram-negative bacteria accounting for 73 .7% ,and 41 gram-positive bacteria accounting for 26 .3% .CONCLUSION The types of stroke , the patient levels of consciousness ,SAP classification ,ward levels and the prophylactic use of antibiotics and other factors are risk factors for MAR infections in elderly patients with SAP ,and the main pathogens are gram-negative bacteria .It has a guiding value for subsequent clinical prevention of MDR .