急性缺血性脑卒中患者卒中相关性肺炎的特点与耐药性分析

Analysis of characteristics and drug resistance of pneumonia in patients with acute ischemic stroke

目的:分析卒中相关性肺炎在急性缺血性脑卒中患者中的危险因素与病原学特点。方法:选取经某院神经内科诊断为脑梗死的323例患者(2017年1月-2018年3月),若发生肺炎,则列为SAP组(48例);若未发生肺炎,则列为非SAP组(275例)。通过对比两组患者的病例资料分析卒中相关性肺炎的促发因素。根据卒中相关性肺炎患者的病原学检测与药敏实验结果,统计分析其病原菌分布与主要致病菌的耐药性。结果:年龄≥70岁、吸烟、既往卒中史、心房纤颤、意识障碍、鼻饲、机械通气、吞咽困难、气管切开或插管、使用脱水剂等是SAP的危险因素(P <0.05)。78株病原菌中检出革兰氏阴性菌53株,检出量最高;其次是革兰氏阳性菌,检出16株;真菌检出量最低,检出9株。肺炎克雷伯菌(KP,18株)检出量最高,鲍曼不动杆菌(AB,17株)紧随其后,其次为铜绿假单胞菌(PA,11株)和金黄色葡萄球菌(SA,10株)。AB对大多数抗菌药物均耐药,但对替加环素高度敏感。KP对头孢类及喹诺酮类耐药率高,对阿米卡星敏感。PA对亚胺培南有较高的耐药率,对阿米卡星、头孢吡肟、妥布霉素敏感性高。SA对红霉素,喹诺酮类环丙沙星、左氧氟沙星,β内酰胺类青霉素、苯唑西林高度耐药,对替加环素、万古霉素、利奈唑胺高度敏感。结论:年龄≥70岁、吸烟、心房纤颤、既往卒中史、吞咽困难、意识障碍、入院后相关侵入性操作、使用脱水剂等是急性缺血性卒中患者SAP的危险因素。SAP的主要病原菌为革兰阴性菌,对抗菌药物耐药现象普遍。临床上应根据病原学特征与药敏结果选用抗菌药物,提高治愈率。

Objective: To analyze risk factors and etiological characteristics of stroke associated pneumonia in patients with acute ischemic stroke. Methods: 323 patients with cerebral infarction in department of neurology of affiliated hospital of Xuzhou Medical University(from January 2017 to March 2018) were divided into stroke associated pneumonia(SAP) group(48 cases) and Non-SAP group(275 cases), the clinical features of cases with SAP for seek inducing factors were analyzed. The distribution of pathogenic bacteria and the resistance of main pathogenic bacteria were statistically analyzed according to the results of pathogeny detection and drug susceptibility test in patients with SAP. Results: The risk factors for SAP included age over 70, smoking, history of previous stroke, atrial fibrillation, disturbance of consciousness, nasal feeding, mechanical ventilation, difficulty swallowing, tracheotomy or tracheal intubation, using of dehydrating agent(P < 0.05). 78 strains of pathogenic bacteria were detected, gram negative bacteria(53 strains) were the most frequently detected, which was followed by Gram-positive bacteria(16 strains), the quantity of fungus was the lowest( 9 strains). Klebsiella pneumoniae(KP, 18 strains) was frequently detected, which was followed by Acinetobacter baumannii(AB, 17 strains), the Pseudomonas aeruginosa(PA, 11 strains) and Staphylococcus aureus(SA, 10 strains), successively. AB was resistant to most antibacterial drugs, but highly sensitive to Tegocycline. KP was resistant to cephalosporins and quinolones, was sensitive to Amikacin. PA was resistant to Imipenem and had high sensitivity to Amikacin, Cefepimeand Tobramycin. SA was highly resistant to Erythromycin, Ciprofloxacin, Levofloxacin, Penicillin, Oxacillin, and highly sensitive to Tegocycline, Vancomycin, and Linezolid. Conclusion: Age over 70, smoking, atrial fibrillation, history of previous stroke, difficulty swallowing, disturbance of consciousness, invasive procedures after admission and using of dehydrating agent are the risk factors for patients with SAP. The main pathogenic bacteria of SAP are gram-negative bacteria, which are generally resistant to antibacterial drugs. Antibacterial drugs should be selected according to the pathogenic characteristics and drug sensitivity results to improve the cure rate.