老年脑梗死并发肺部感染病原菌耐药性与影响因素

Drug resistance and influencing factors of pathogen bacteria in elderly patients with cerebral infarction complicated with pulmonary infection

目的探讨老年脑梗死患者合并肺部感染病原菌耐药性与影响因素分析,为脑梗死患者肺部感染的预防提供依据。方法选择2017年1月-2018年6月天津市宝坻区人民医院收治的老年脑梗死患者189例,分析患者并发肺部感染情况,检测患者病原菌感染类型,并分析病原菌耐药性,归纳老年脑梗死患者并发肺部感染的影响因素。结果189例患者中,其中发生肺部感染患者72例,肺部感染率为38.10%。72例肺部感染患者中分离病原菌85株,其中革兰阴性菌61株占71.76%,以肺炎克雷伯菌和铜绿假单胞菌为主;革兰阳性菌19株占22.35%,以金黄色葡萄球菌为主;真菌5株占5.88%。肺炎克雷伯菌对呋喃妥因耐药率较高为64.71%,铜绿假单胞菌对呋喃妥因耐药率为100.00%,鲍氏不动杆菌对头孢曲松、呋喃妥因耐药率为100.00%,均对哌拉西林/他唑巴坦和亚胺培南敏感;金黄色葡萄球菌对红霉素、氨苄西林耐药率较高为100.00%、85.71%。侵入性治疗、糖尿病、中重度脑梗死及昏迷是老年脑梗死患者肺部感染的影响因素(P<0.05)。结论老年脑梗死合并肺部感染患者病原菌主要以革兰阴性菌为主,临床治疗应根据病原菌药敏结果进行抗菌药物的选择;感染影响因素较多,应针对各因素采取有效的防治措施。

OBJECTIVE To investigate the drug resistance and influencing factors of pathogen bacteria in elderly patients with cerebral infarction complicated with pulmonary infection,so as to provide evidence for the prevention of pulmonary infection in patients with cerebral infarction.METHODS Totally 189 cases of elderly patients with cerebral infarction admitted to Baodi District People’s Hospital of Tianjin City from Jan.2017 to Jun.2018 were selected as subject.The incidence of pulmonary infection was analyzed,the types of pathogenic bacteria infection were detected,and the drug resistance of pathogenic bacteria was analyzed,so as to summarize the influencing factors of pulmonary infection in elderly patients with cerebral infarction.RESULTS Of 189 patients,72 cases had pulmonary infection,and the incidence of pulmonary infection was 38.10%.Among 72 patients with pulmonary infection,85 strains of pathogens were isolated,of which 61 strains were gram-negative accouted for 71.76%,mainly Klebsiella pneumoniae and Pseudomonas aeruginosa;19 strains of Gram-positive accouted for 22.35%,dominated by gold Staphylococcus sureus;and 5 strains of fungi accouted for 5.88%.The resistance rate of K.pneumoniae to furantoin was 64.71%,that of P.aeruginosa to furantoin was 100.00%,that of Acinetobacter baumannii to ceftriaxone and furantoin was 100.00%,that of all strains to piperacillin/tazobactam and imipenem were sensitive,and that of Staphylococcus aureus to erythromycin and ampicillin was 100.00%and 85.71%.Univariate and logistic regression analysis showed that invasive therapy,diabetes mellitus,moderate to severe cerebral infarction and coma were independent risk factors for elderly cerebral infarction complicated with pulmonary infection(P<0.05).CONCLUSION Gram-negative bacteria were the main pathogens of pulmonary infection in elderly patients with cerebral infarction.The clinical treatment should be based on the results of drug sensitivity.There are many factors affecting infection,and effective prevention and treatment measures should be taken for each factor.