卒中相关性肺炎发生多药耐药菌感染的危险因素研究

Study on risk factors of stroke-related pneumonia infection by multidrug-resistant bacteria

目的研究卒中相关性肺炎(SAP)发生多药耐药菌(MDR)感染的危险因素及病原菌,以尽早识别SAP并采取预防措施。方法选取2016年6月至2018年12月该院神经疾病中心老年脑卒中患者680例,其中SAP患者156例。对患者临床资料进行回顾性分析,对发生MDR感染的危险因素进行单因素及多因素分析,并分析病原菌。结果156例SAP患者中,有69例发生MDR感染,感染率为44.2%。MDR感染与年龄、卒中类型、意识水平、冠心病、慢性肺部疾病史、合并吞咽困难、留置胃管、气管插管及预防性应用抗菌药物相关(P<0.05),与患者性别、吸烟史、糖尿病、高血压、静脉溶栓无关(P>0.05)。MDR感染患者共分离出47株病原菌,其中革兰阴性菌27株(占57.4%),革兰阳性菌15株(占31.9%)。结论年龄、卒中类型、意识水平、冠心病、慢性肺部疾病史、合并吞咽困难、留置胃管、气管插管及预防性应用抗菌药物是老年SAP患者发生MDR感染的危险因素,病原菌以革兰阴性菌为主。

Objective To study the risk factors and pathogens of stroke-associated pneumonia(SAP)multi-drug resistant bacteria(MDR)infection,so as to identify SAP as soon as possible and take preventive measures.Methods From June 2016 to December 2018,680 elderly stroke patients in the neurological disease center of the hospital were selected,of which 156 were SAP patients.The clinical data of patients were retrospectively analyzed,single-factor and multi-factor analysis of risk factors for MDR infection were conducted,and pathogenic bacteria were analyzed.Results Among 156 SAP patients,69 had MDR infection,and the infection rate was 44.2%.MDR infection was related to age,stroke type,level of consciousness,coronary heart disease,history of chronic lung disease,dysphagia,indwelling gastric tube,tracheal intubation,and preventive use of antibiotics(P<0.05).MDR infection was not related to gender,smoking history,diabetes,hypertension,intravenous thrombolysis(P>0.05).A total of 47 pathogens were isolated from patients with MDR infection,including 27 Gram-negative bacteria(57.4%)and 15 Gram-p ositive bacteria(31.9%).Conclusion Age,stroke type,level of consciousness,coronary heart disease,history of chronic lung disease,combined dysphagia,indwelling gastric tube,tracheal intubation,and preventive use of antibiotics are risk factors for MDR infection in elderly SAP patients.The pathogenic bacteria are mainly Gram-negative bacteria.