脑卒中呼吸机相关性肺炎多重耐药感染的危险因素及病原学分析

Risk factors and pathogenicity analysis of multi-drug resistant bacterial infection in ventilator-associated pneumonia

目的分析脑卒中呼吸机相关性肺炎患者发生多重耐药感染的危险因素及病原学特点。方法回顾性分析2016年1月至2017年4月于本院神经内科行机械通气治疗的82例脑卒中患者的临床资料,包括年龄、性别、合并基础疾病、侵入性操作等因素,对以上因素分别给予单因素和多因素Logistic回归分析,采集患者相关标本,采用全自动细菌培养分析仪对细菌进行培养鉴定。结果 82例行机械通气治疗的脑卒中患者中共有39例(47.56%)发生呼吸机相关性肺炎,共检出多重耐药菌67株,其中革兰阴性菌以鲍曼不动杆菌和铜绿假单胞菌为主,革兰阳性菌以金黄色葡萄球菌为主,铜绿假单胞菌和鲍曼不动杆菌对氨苄西林、氨苄西林/舒巴坦、头孢哌酮的耐药率均较高,金黄色葡萄球菌和表皮葡萄球菌对头孢唑林、青霉素及阿奇霉素的耐药率高达100.0%,但其对万古霉素、替考拉宁及利奈唑胺均无耐药性。年龄>60岁、抗菌药物使用≥2种、存在意识障碍及血清白蛋白水平<30 g/L均为脑卒中呼吸机相关性肺炎患者发生多重耐药的独立危险因素(P<0.05)。结论导致脑卒中呼吸机相关性肺炎多重耐药感染的危险因素较多,因此在预防上应依据其危险因素采取合理措施,同时临床上要依据患者病原学特征和药敏试验结果加强抗菌药物的合理使用,避免耐药菌株的出现,提高临床疗效。

Objective To analyze the risk factors and etiological characteristics of multi-drug resistance in ventilator-associated pneumonia in patients with stroke-associated pneumonia. Method The clinical data of 82 stroke patients who underwent mechanical ventilation in our department from January 2016 to April 2017 were retrospectively analyzed, including age, gender, associated underlying diseases, and invasive procedures. Relevant factors were given to univariate and multivariate Logistic regression analysis, and patient-related specimens were collected using a fully automated bacterial culture analyzer. Result In 82 stroke patients treated with mechanical ventilation, 39 patients developed ventilator associated pneumonia, with an incidence rate of 47.56%. A total of 67 strains of multi-drug resistant bacteria were detected, Gram-negative bacteria mainly consisted Acinetobacter baumannii and Pseudomonas aeruginosa, and Gram-positive bacteria mainly consisted Staphylococcus. Commonly used antibiotics had different levels of drug resistance, including Pseudomonas aeruginosa and Acinetobacter baumannii to Ampicillin, Aampicillin/Sulbactam, Cefoperazone. The drug resistance rate were higher. Gram-positive bacteria golden yellow grape balls and Staphylococcus epidermidis resistant rates to Cefazolin, Penicillin and Azithromycin were as high as 100.0%, but their resistance to Vancomycin, Teicoplanin and Linezolid has no drug resistance. Age 60 years old, antibiotic use ≥ 2 kinds, presence of consciousness disorder, and serum albumin level 〈30 g/L were the independent risk factors for the occurrence of multiple resistance of ventilator associated pneumonia in stroke patients（P〈0.05）. Conclusion There are relatively more risk factors for multi-drug resistant infections in strokeassociated pneumonia patients. Therefore, precautions must be taken based on their risk factors, and clinically based on the patient＇s pathogens. Characteristics and drug susceptibility test results enhance the rational use of antibiotics, avoid the emergence of drugresistant strains, and improve clinical efficacy.