脑卒中患者尿路感染的危险因素分析及病原菌分布

The risk factor analysis and pathogenic bacteria distribution of stroke patients with urinary tract infections

目的：探讨老年脑卒中住院康复患者尿路感染的危险因素及病原菌分布、耐药性。方法随机选取2010年12月-2013年1月368例老年脑卒中住院康复患者为研究对象，对其中的42例尿路感染患者的危险因素、病原菌分布及耐药性进行分析，数据采用SPSS13．0统计软件进行处理。结果368例脑卒中患者中发生尿路感染42例，感染率为11．4％；其发生尿路感染的危险因素有高龄（＞70岁）、留置导尿、糖尿病、Brunstrom功能分期（4～6级）、低蛋白血症、康复时间长、出血性脑卒中、病程长（＞6个月），差异有统计学意义（P＜0．05）；共检出病原菌47株，其中革兰阴性菌占51．2％、革兰阳性菌占27．6％、真菌占21．2％；革兰阴性菌仅对亚胺培南、头孢噻肟、阿米卡星敏感性较高，革兰阳性菌对呋喃妥因、利奈唑胺、万古霉素的敏感性高，而真菌对抗菌药物的敏感性均较高。结论老年脑卒中患者尿路感染的危险因素较多，感染病原菌以大肠埃希菌为主，应重视老年脑卒中患者感染菌的监测，选择敏感的抗菌药物对症治疗。

OBJECTIVE To study the risk factors ,pathogenic bacteria distribution and drug resistance of elderly stroke hospitalized recovery patients with urinary tract infections .METHODS Elderly stroke recovery patients in hospital of 368 cases during Dec .2010 to Jan .2013 were randomly selected as the research objects ,and risk factors ,pathogenic bacteria distribution and drug resistance of 42 cases patients with urinary tract infection therein were analyzed .Data were measured by the statistical software SPSS13 .0 .RESULTS In 368 cases stroke patients, there were 42 cases had urinary tract infections with the infection rate of 11 .4% .The risk factors that would lead to the urinary tract infections were as followed：advanced age（〉70 years old） ,retention catheterization ,diabetes, Brunstrom function staging（4~6 calss） ,hypoproteinemia ,long recovery ,hemorrhagic stroke ,long duration （〉6 months） ,and the differences had significance （P〈0 .05） .Totally 47 strains pathogenic bacteria were detection, including gram-negative bacteria （51 .2% ）, gram-positive bacteria （27 .6% ） ,fungi （21 .2% ） . Gram-negative bacteria had higher sensibility to imipenem ,cefotaxime and amikacin .Gram-positive bacteria had higher sensibility to macrodantin ,linezolid ,vancomycin ,and fungi had higher sensibility to antibacterial agents .CONCLUSIONS The risk factors of urinary tract infection in elderly stroke patients are more .The main pathogenic bacteria of urethral infection in patients were Escherichia coli .Therefore ,infection bacteria monitoring should be emphasized and sensitive antibiotics should be choosed for patients with stroke .