老老年复发脑卒中合并重症肺炎患者的病原菌分布和抗生素应用分析

Pathogens Distribution and Antibiotic Uses in Very Elderly Patients with Recurrent Stroke Complicated with Severe Pneumonia

目的探究老老年复发脑卒中合并重症肺炎患者的病原菌分布情况和抗生素应用分析。方法选择西安交通大学第二附属医院老老年复发脑卒中合并重症肺炎患者共168例,统计分析感染菌群类型和比例,敏感抗生素类型和比例,分析患者预后与感染菌群类型、菌群耐药数量以及培养时间的关系。结果初检阳性率46.3%,经多次送检阳性率为79.8%,多次送检可提高阳性率(P<0.05);革兰氏阴性菌(G-)感染率高于革兰氏阳性菌(G+)和真菌(P<0.05);2种菌群感染患者比例最高(P<0.05)。患者应用抗生素类型以头孢类最多,其次为青霉素类和喹诺酮类(P<0.05);2种抗生素联合应用比例最多(P<0.05)。预后较差患者感染G-菌比例高于预后较好患者,联合感染比例升高,联合应用抗生素种类增多,降阶梯治疗次数增加(P<0.05)。多因素logistic回归分析可知,病原菌分布、抗生素种类、菌群培养时间是影响预后的独立危险因素(P<0.05)。结论菌群感染是导致老老年复发脑卒中合并重症肺炎患者预后不佳的重要因素,早期多次送检和药敏试验可显著改善临床效果。

Objective To analyze the pathogens distribution and antibiotic uses in very elderly patients with recurrent stroke complicated with severe pneumonia.Methods A total of 168 very elderly patients with recurrent stroke complicated with severe pneumonia were enrolled in the Second Affiliated Hospital of Xi'an Jiaotong University.The type and proportion of pathogen,and sensitive antibiotics were tested.The relationship between the prognosis and pathogen types,numbers of antibiotic resistance and length of pathogen culture was analyzed.Results The positive rate of initial examination was 46.3%,while the positive rate elevated to 79.8%with multi-examinations which increased the positive rate(P<0.05).The rate of Gram-negative(G-)bacterial infection was higher than that of Gram-positive(G+)bacterial and fungi infection(P<0.05).The proportion of patients infected by two types of pathogens was the highest(P<0.05).Cephalosporins were the most frequently used,followed by penicillins and quinolones(P<0.05).The proportion of combined use of two antibiotics was the most(P<0.05).The proportion of G-bacterial infection,mixed bacterial infection and combined use of antibiotics,and frequency of de-escalation therapy were higher in patients with poor prognosis than those in patients with good prognosis(P<0.05).Multivariate logistic regression analysis demonstrated that the distribution of pathogens,types of antibiotics and the length of bacterial culture were the independent risk factors for prognosis(P<0.05).Conclusion Pathogen infection might be the critical factors leading to poor prognosis in very elderly patients with recurrent stroke combined with severe pneumonia.