老年脑卒中相关性肺炎患者多药耐药菌感染病原学及相关因素探讨

Exploration of etiology and related factors of multidrug-resistant bacterial infection in elderly patients with stroke associated pneumonia

目的分析脑卒中相关肺炎(SAP)中老年患者中出现多药耐药菌者的临床特征、病原菌感染特点和耐药性特点,为临床防治SAP多药耐药菌感染提供参考依据。方法选取2013-2015年60岁以上接受诊治的脑卒中SAP患者269例为观察对象,对所有患者痰液样本进行病原菌和耐药性检测,分析多药耐药菌感染SAP的病原学和药敏学特点,并分析其感染危险因素。结果 SAP并发多药耐药菌感染率为55.76%;logistic回归分析显示侵入性操作、意识水平、神经功能缺损程度、SAP类型、预防性应用抗菌药物为SAP多耐药菌感染的独立危险因素(P<0.01);SAP多药耐药菌感染病原菌主要为革兰阴性菌;革兰阴性菌敏感性最佳的药物为加替沙星,敏感率为100.00%。结论多种因素均能够增加老年SAP患者容易出现多药耐药菌感染的风险。

OBJECTIVE To analyze the clinical characteristics, pathogenic bacteria infection and drug resistance characteristics of stroke patients with stroke associated pneumonia （SAP） in middle-aged and elderly patients, so as to provide a basis for clinical prevention and treatment of SAP multidrug resistance infection. METHODS A to- tal of 269 cases of patients with SAP aged more than 60 years were selected as the objects. The pathogens and drug resistance of sputum samples were detected, and the etiology and drug sensitivity characteristics of multi- drug-resistant bacterial infection in SAP were analyzed. The risk factors of SAP were analyzed. RESULTS The in- fection rate of SAP was 55.76%. Logistic regression analysis showed that invasive operation, consciousness level, neurological deficit degree, SAP type and prophylactic use of antibiotics were the independent risk factors of SAP （P〈0.01）. The main pathogens of SAP multidrug-resistant bacteria were gram-negative bacteria. The most sen- sitive drug of gram-negative bacteria was gatifloxacin, with the sensitive rate of 100.00%. CONCLUSION Multiple factors can increase the risk of multidrug--resistant infections in elderly SAP patients.