老年脑卒中相关性肺炎病人多药耐药菌感染的危险因素分析

Risk factors of multidrug resistance infection in elderly patients with stroke-related pneumonia

目的探讨老年脑卒中相关性肺炎(SAP)病人发生多药耐药菌(MDR)感染的临床特点及危险因素,为临床防治老年SAP提供依据。方法回顾性分析2013年3月至2016年3月医院收治的157例老年脑卒中病人临床资料,其中39例病人发生SAP,SAP病人发生MDR感染27例,分析其感染病原菌分布及耐药性,单因素和多因素分析SAP病人发生MDR感染的危险因素。结果 39例SAP病人发生MDR感染27例,感染率为69.23%,分离出MDR病原菌51株,其中革兰阴性菌占68.63%,主要为鲍氏不动杆菌、肺炎克雷白菌;革兰阳性菌占17.65%,主要为金黄色葡萄球菌;真菌占13.72%,主要为白色假丝酵母菌。除肺炎克雷白菌对美罗培南、亚胺培南的耐药率为0,金黄色葡萄球菌对万古霉素、替考拉宁的耐药率为0,其他病原菌显示多药耐药性;经多因素Logistic回归分析,SAP病人发生MDR感染的独立危险因素为意识障碍、晚发性肺炎、预防性应用抗菌药物(P<0.05)。结论老年SAP病人发生MDR感染的病原菌主要为革兰阴性菌,MDR感染发生率较高,发生MDR感染相关危险因素较多,与意识障碍、晚发性肺炎、预防性应用抗菌药物有关,采取对应措施及针对性选择抗菌药物有利于控制感染。

Objective To explore the clinical features and risk factors of multidrug resistance（ MDR） infection in elderly patients with stroke-related pneumonia（ SAP）,in order to provide evidence for clinical prevention and treatment of SAP. Methods A total of 157 elderly patients with stroke from March 2013 to March 2016 in hospital were selected,and 39 patients occured SAP. The clinical data was retrospectively analyzed. The distribution of pathogens and drug resistance was analyzed. The risk factors of MDR infection in elderly patients with SAP were analyzed by univariate and multivariate analysis.Results Twenty-seven patients with SAP presented with MDR infection,with an infection rate of69. 23%. Fifty-one strains of MDR pathogens were isolated. Gram-negative bacteria accounted for68. 63%,the most common strain of which were acinetobacter baumannii,Klebsiella pneumonia. Positive bacteria accounted for 17. 65%,the most common strain of which was Staphylococcus aureus. Fungi accounted for 13. 72%,the most common strain of which was Candida albicans. Resistance rate of Klebsiellapneumoniae to meropenem,imipenem was 0,and resistance rate of Staphylococcus aureus to vancomycin,teicoplanin was 0. Other pathogens showed MDR. Logistic regression analysis showed that consciousness disorder,late-onset pneumonia,prophylactic antibiotics were independent risk factors of MDR infection in elderly patients with SAP（ P〈0. 05）. Conclusions The results show that the main pathogens are Gram-negative bacterias in elderly patients with stroke-associated pneumonia. SAP patients show high incidence rate of MDR infection. The risk factors related to MDR infection in SAP patients are consciousness disorder,late-onset pneumonia,and prophylactic antibiotics.