脑卒中患者耐碳青霉烯类肠杆菌感染的临床特征与影响因素分析

Clinical characteristics and influencing factors of carbapenem resistant Enterobacter infection in stroke patients

目的探讨脑卒中患者耐碳青霉烯类肠杆菌感染的临床特征与影响因素。方法选取2018年1月~2019年12月收治的118例脑卒中耐碳青霉烯类肠杆菌感染患者进行回顾性分析,分析所有患者临床痰液、引流液、血液、脑脊液或尿液等检测细菌培养结果、病原菌分布情况以及主要病原菌耐药情况,将其分为感染组。另选取同期未出现耐碳青霉烯类肠杆菌感染的100例脑卒中患者作为未感染组,应用单因素与多因素Logistic回归分析分析脑卒中患者耐碳青霉烯类肠杆菌感染的影响因素。结果118例患者菌株数共139株,病原菌主要为肺炎克雷伯菌113株(81.29%),其次为产气肠杆菌12株(8.63%);标本分离的主要病原菌为多重耐药或泛耐药菌,对替加环素和复方新诺明的敏感率稍高,氨基糖苷类敏感率为19.47%,多粘菌素敏感率只有7.08%,其余抗菌药物均100%耐药;感染组与未感染组患者性别、年龄、手术史、既往住院史、合并疾病情况对比无明显差异(P>0.05),感染组患者住院时间>14 d、抗菌药物使用时间>14 d、侵入性治疗和合并意识障碍的患者人数明显高于未感染组(P<0.05);Logistic回归分析结果表明:抗菌药物使用时间、侵袭性治疗、意识障碍为脑卒中患者耐碳青霉烯类肠杆菌感染的独立危险因素(P<0.05)。结论脑卒中患者耐碳青霉烯类肠杆菌感染患者的主要病原菌为肺炎克雷伯菌和产气肠杆菌,对替加环素和复方新诺明的敏感性较高。另外本研究还表明,抗菌药物使用时间、侵入性治疗、意识障碍为脑卒中患者耐碳青霉烯类肠杆菌感染的独立危险因素。

Objective To investigate the clinical characteristics and influencing factors of carbapenem resistant Enterobacter infection in stroke patients.Methods 118 stroke patients with carbapenem resistant Enterobacter infection treated in our hospital from January 2018 to December 2019 were retrospectively analyzed.The bacterial culture results,pathogen distribution and drug resistance of main pathogens in clinical sputum,drainage fluid,blood,cerebrospinal fluid or urine of all patients were analyzed,and they were divided into infection group.In addition,100 stroke patients without carbapenem resistant Enterobacter infection in the same period were selected as the uninfected group.The influencing factors of carbapenem resistant Enterobacter infection in stroke patients were analyzed by univariate and multivariate Logistic regression analysis.Results There were 139 strains in the 118 patients.The main pathogen was 113 Klebsiella pneumoniae(81.29%),followed by 12 Enterobacter aerogenes(8.63%).The main pathogens isolated from the samples were multidrug-resistant or pan drug-resistant bacteria.The sensitivity rate to tegacyclin and cotrimoxazole was slightly higher,the sensitivity rate to aminoglycosides was 19.47%,the sensitivity rate to polymyxin was only 7.08%,and the other antibiotics were 100%resistant;There was no significant difference in gender,age,operation history,previous hospitalization history and combined diseases between the infected group and the uninfected group(P>0.05).The number of patients in the infected group with hospitalization time>14 days,antibiotics use time>14 days,invasive treatment and combined consciousness disorder was significantly higher than that in the uninfected group(P<0.05);Logistic regression analysis showed that the use time of antibiotics,invasive treatment and disturbance of consciousness were independent risk factors for carbapenem resistant Enterobacter infection in stroke patients(P<0.05).Conclusion The main pathogens of stroke patients infected with carbapenem resistant Enterobacteriaceae are Klebsiella pneumoniae and Enterobacter aerogenes,and they are highly sensitive to tegacyclin and cotrimoxazole.In addition,this study also showed that the use time of antibiotics,invasive treatment and disturbance of consciousness were the independent risk factors of carbapenem resistant Enterobacter infection in stroke patients.