急性脑卒中患者下呼吸道多重耐药菌感染的危险因素分析

Analysis of risk factors for multidrug-resistant bacterial infections in lower respiratory tract of patients with acute stroke

目的探讨急性脑卒中患者下呼吸道多重耐药菌感染的危险因素。方法选择2016年1月至2018年4月在西安医学院第二附属医院就诊的602例急性脑卒中患者作为研究对象。翻阅患者病历资料,记录患者的一般情况、个人史、既往史、卒中性质、卒中部位、发病至住院时间、入院途径、格拉斯哥昏迷评分(GCS)、机械通气、低蛋白血症、抑酸药物应用、吞咽困难、手术治疗、鼻饲置管、应用抗生素、吸痰等资料,观察上述资料与多重耐药菌感染发生的相关性。结果 602例脑卒中患者,其中114例发生下呼吸道感染菌中有61例患者发生下呼吸道多重耐药菌感染;单因素分析显示,抑酸药物应用、吸烟、高血压、卒中位置、尿管、外科手术史、饮酒、过敏史不是影响急性脑卒中患者下呼吸道多重耐药菌感染的危险因素(P>0.05),鼻饲置管、高脂血症、吞咽困难、低蛋白血症、发病至入院时间、性别、慢性阻塞性肺疾病、体质量指数、糖尿病、年龄、卒中性质、GCS评分、前期碳青霉烯类药物、ICU住院时间、机械通气、手术治疗是影响急性脑卒中患者下呼吸道多重耐药菌感染的危险因素(P<0.05);多因素二分类Logistic回归分析结果显示,年龄>75岁、前期碳青霉烯类抗生素应用、吞咽障碍、院外转入、ICU住院时间≥72 h、机械通气>7 d是影响急性脑卒中下呼吸道多重耐药菌感染的独立危险因素(P<0.05),GCS≥9分是急性脑卒中下呼吸多重耐药菌感染的保护性因素(P<0.05)。结论急性脑卒中患者下呼吸道多重耐药菌感染是多因素综合作用的结果,临床应注意根据危险因素进行针对性防控以减少多重耐药菌的发生。

Objective To explore the risk factors of multidrug-resistant bacterial infections in lower respiratory tract of patients with acute stroke. Methods A total of 602 patients with acute stroke, who were treated in the Second Affiliated Hospital of Xi’an Medical University from January 2016 to April 2018, were selected as the research subjects.We checked the patient’s medical records and recorded the patient’s general situation, personal history, past history,stroke nature, stroke location, onset to hospital time, admission route, Glasgow coma score(GCS), mechanical ventilation, hypoproteinemia, acid suppressor application, dysphagia, surgical treatment, nasogastric tube placement, antibiotics phlegm absorption and other data. The correlation between the above data and the occurrence of multidrug-resistant bacterial infections was analyzed. Results Among the 602 patients with stroke, there were 61 cases of multidrug-resistant bacterial infection in lower respiratory tract and 114 strains of pathogens isolated from 61 patients. The single factor analysis showed that acid suppressor using, smoking, hypertension, stroke position, urethral catheter, surgical history, drinking, and allergy were not the risk factors for multidrug-resistant lower respiratory tract infection in acute stroke patients(P>0.05), and nasogastric feeding, hyperlipidemia, dysphagia, hypoproteinemia, onset to admission, gender, chronic obstructive pulmonary disease, body mass index, diabetes, age, stroke nature, GCS score, prophase carbapenems, ICU hospitalization, mechanical ventilation, hand treatment were the risk factors for multidrug-resistant bacterial infections in lower respiratory tract of patients with acute stroke(P<0.05). Logistic analysis showed that age>75 years old, early application of carbenes antibiotics, dysphagia, extra hospital transfer, ICU hospitalization longer than 72 h, mechanical ventilation>7 d were independent risk factors(P<0.05), and the GCS score≥9 was the protective factor of respiratory multidrug-resistant bacteria infection in acute stroke(P<0.05). Conclusion The multidrug-resistant bacterial infection in the lower respiratory tract of acute stroke patients is the result of multiple factors. It should be paid attention to the prevention and control according to the risk factors in order to reduce the occurrence of multidrug resistant bacterial infection.