老年脑卒中患者医院感染病原学及危险因素分析

Etiology and risk factors of nosocomial infection in elderly stroke patients

目的 了解老年急性脑卒中肺部医院感染患者危险因素和病原菌分布,为老年脑卒中患者医院感染防治提供依据。方法 回顾性分析川北医学院附属医院健康管理中心2015-2020年510例60岁以上老年脑卒中患者临床资料,对感染因素进行分析。对患者分离病原菌进行鉴定并对大肠埃希菌和肺炎克雷伯菌进行药敏试验。设计TEM、SHV、CTX-M、OXA引物并利用PCR技术分析产ESBLs大肠埃希菌进行扩增。结果 共计分离出65株病原菌,其中革兰阳性菌23株,金黄色葡萄球菌、肺炎链球菌、肠球菌分别为11、7和5株;革兰阴性菌40株,大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌分别为18、13、6和3株;真菌2株,白色假丝酵母菌和光滑假丝酵母菌各1株。大肠埃希菌对四环素、头孢他啶、头孢吡肟、诺氟沙星、环丙沙星、庆大霉素、阿米卡星、哌拉西林、哌拉西林-他唑巴坦、美罗培南和亚胺培南耐药率为61.11%、44.44%、33.33%、50.00%、50.00%、38.89%、11.11%、61.11%、5.56%、5.56%和5.56%。肺炎克雷伯菌对四环素、头孢他啶、头孢吡肟、诺氟沙星、环丙沙星、庆大霉素和哌拉西林耐药率分别为53.85%、38.46%、38.46%、46.15%、38.46%、30.77%和61.54%。8株产ESBLs大肠埃希菌中CTX-M型引物扩增阳性为6株,TEM型引物扩增出阳性3株和OXA型引物扩增阳性为1株。年龄、住院时间、高血脂、糖尿病、低蛋白血症、侵入性操作、意识障碍和吞咽障碍是老年脑卒中患者易发医院感染的因素。结论 老年脑卒中患者医院感染中大肠埃希菌和肺炎克雷伯菌是主要致病菌。治疗时应依据药敏试验结果给予抗生素治疗。

Objective To understand the risk factors and pathogen distribution of pulmonary nosocomial infection in elderly patients with acute stroke,so as to provide basis for the prevention and treatment of nosocomial infection in elderly patients with stroke.Methods The clinical data of 510 stroke patients over 60 years old in the health management center of the Affiliated Hospital of North Sichuan Medical College from 2015 to 2020 were analyzed retrospectively,and the infection factors were analyzed.The pathogenic bacteria isolated from patients were identified,and the drug sensitivity tests of Escherichia coli and Klebsiella pneumoniae were carried out.The primers of TEM,SHV,CTX-M and OXA were designed,and the ESBLs producing Escherichia coli was analyzed by PCR.Results A total of 65 strains were isolated.Among Gram-positive bacteria,Staphylococcus aureus,Streptococcus pneumoniae and Enterococcus were 11,7 and 5 strains respectively;Among Gram-negative bacteria,E.coli,K.pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa were 18,13,6 and 3 strains respectively;Among the fungi,Candida albicans and Candida glabrata were 1 strain each.The resistance rates of Escherichia coli to tetracycline,ceftazidime,cefepime,norfloxacin,ciprofloxacin,gentamicin,amikacin,piperacillin,piperacillin tazobactam,meropenem and imipenem were 61.11%,44.44%,33.33%,50.00%,50.00%,38.89%,11.11%,61.11%,5.56%,5.56% and 5.56%.The resistance rates of K.pneumoniae to tetracycline,ceftazidime,cefepime,norfloxacin,ciprofloxacin,gentamicin and piperacillin were 53.85%,38.46%,38.46%,46.15%,38.46%,30.77% and 61.54% respectively.Among the 8 ESBLs producing E.coli strains,CTX-M primer amplification was positive in 6 strains,TEM primer amplification was positive in 3 strains and OXA primer amplification was positive in 1 strain.Age,length of stay,hyperlipidemia,diabetes,hypoproteinemia,invasive operation,disturbance of consciousness and dysphagia were the risk factors of hospital infection in elderly stroke patients.Conclusion E.coli and K.pneumoniae were the main pathogens of nosocomial infection in elderly stroke patients.Antibiotics should be given according to the results of drug sensitivity test.