老年卒中相关性肺炎危险因素及病原菌耐药性分析

Risk factors and drug resistance of pathogenic bacteria in senile stroke-associated pneumonia

目的分析老年卒中相关性肺炎(senile stroke-associated pneumonia,SAP)危险因素及病原菌耐药性,为临床早期干预提供参考。方法选取邯郸市第一医院2018年6月至2020年6月期间收治的859例老年脑卒中患者,根据患者是否发生卒中相关性肺炎患者分为研究组(SAP,n=375)和对照组(未发生SAP,n=484),分析两组年龄、性别、并发症等临床资料,对老年SAP患者进行痰培养和药敏试验分析。结果375例SAP患者中共检出313株病原菌,其中革兰氏阴性菌共211株(67.41%),主要是以鲍曼不动杆菌92株(29.39%)、铜绿假单胞菌54株(17.25%)、肺炎克雷伯菌42株(13.42%)为主;革兰氏阳性菌共73株(23.32%),主要是金黄色葡萄球菌62株(19.81%);真菌共29株(9.27%)。铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶高度敏感;鲍曼不动杆菌和肺炎克雷伯杆菌对亚胺培南、美罗培南和头孢哌酮钠舒巴坦钠高度敏感;金黄色葡萄球菌和肠球菌对替考拉宁、利奈唑胺和万古霉素高度敏感。实验组患者年龄≥80岁、机械通气、卧床、使用预防性抗菌药物比例显著高于对照组(P<0.05);logistic回归分析结果显示年龄≥80岁、机械通气、低蛋白血症、使用预防性抗菌药物是SAP发生的独立危险因素(P<0.05)。结论老年卒中相关性肺炎以铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌为主,根据药敏结果合理地选用抗生素,危险因素是患者年龄≥80岁、机械通气、卧床等,临床医师应高度重视老年卒中相关性肺炎的预防。

Objective To analyze the risk factors and pathogen drug resistance of senile stroke-associated pneumonia(SAP),and to provide references for early clinical intervention.Methods A total of 859 elderly patients with cerebral stroke admitted to our hospital from June 2018 to June 2020 were selected and divided into the study group(SAP,n=375)and the control group(no SAP,n=484)according to the occurrence of stroke associated pneumonia.Clinical data of age,gender,and other complications of the two groups were analyzed.The sputum culture and drug sensitivity test of senile SAP patients were analyzed.Results A total of 313 pathogens were detected in 375 SAP patients,including 211 strains of gram-negative bacteria(67.41%),mainly consisting of 92 Acinetobacter baumannii(29.39%),54 Pseudomonas aeruginosa(17.25%),and 42 Klebsiella pneumoniae(13.42%),and 73 strains(23.32%)of gram-positive bacteria,mainly 62 strains of Staphylococcus aureus(19.81%).In addition,there were 29 strains of fungi(9.27%).Pseudomonas aeruginosa was highly sensitive to piperacillin/tazobactam and ceftazidime.Acinetobacter baumannii and Klebsiella pneumoniae were highly sensitive to imipenem,meropenem,and cefoperazone sodium and sulbactam sodium.Staphylococcus aureus and Enterococcus were highly sensitive to teicolanin,linezolid and vancomycin.The proportion of patients aged≥80 years old,mechanical ventilation,bed rest and use of prophylactic antibiotics in the experimental group was significantly higher than that in the control group(P<0.05).Logistic regression analysis showed that age≥80 years,mechanical ventilation,hypoproteinemia and use of prophylactic antibiotics were independent risk factors for SAP(P<0.05).Conclusion The main pathogens of stroke-associated pneumonia in the elderly are Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii.It is necessary to rationally choose antibiotics according to the results of drug sensitivity.The risk factors are patients′age≥80 years old,mechanical ventilation,and bed rest.Clinicians should attach great importance to the prevention of stroke-related pneumonia in the elderly.