老年脑卒中合并肺部感染患者痰培养病原菌分布及耐药情况调查

Investigation on distribution and drug resistance of pathogenic bacteria in sputum culture in elderly patients with stroke complicated with pulmonary infection

目的探究老年脑卒中合并肺部感染患者痰培养病原菌分布及耐药情况。方法选取2018年4月-2021年12月成都医学院第一附属医院收治的108例脑卒中合并肺部感染老年患者,根据神经功能缺损(NIHSS)评分将患者分为轻度组(NIHSS评分<7分)(n=32)、中度组(NIHSS评分7~15分)(n=45)、重度组(NIHSS评分>15分)(n=31)。采集入组患者痰液进行痰培养,对阳性结果的标本进行病原菌及耐药性的统计分析。结果所有患者的痰液标本共分离出125株病原菌,革兰阴性菌占67.20%,革兰阳性菌占14.40%,真菌占18.40%,其中铜绿假单胞菌感染占比最高(34/125,27.20%);重度组真菌感染率高于轻度组及中度组,差异有统计学意义(P<0.05);革兰氏阴性菌对于碳青霉烯类药物(亚胺培南、美罗培南)和喹诺酮类(环丙沙星、左氧氟沙星)等药物的耐药率总体较低,而对氨苄西林、头孢类和磺胺类药物的耐药率较高;革兰氏阳性菌对万古霉素、呋喃妥因和利奈唑胺耐药率较低,对青霉素类和喹诺酮类(左氧氟沙星)的耐药率较高;真菌对抗菌药物的耐药率普遍较低。结论老年脑卒中合并肺部感染患者痰培养的病原菌以革兰氏阴性菌为主,真菌感染率高于革兰氏阳性菌,且重度脑卒中患者更易遭受真菌感染。感染患者多重耐药情况普遍存在,应密切结合临床,合理用药,有效应对感染,同时避免耐药菌的广泛传播。

Objective To explore the distribution and drug resistance of pathogenic bacteria in sputum culture in elderly patients with stroke complicated with pulmonary infection.Methods 108 elderly patients with stroke complicated with pulmonary infection who were treated in First Affiliated Hospital of Chengdu Medical College between April 2018 and December 2021 were selected.According to the neurologic impairment score(NIHSS),the patients were divided into mild group(NIHSS score<7 points,n=32),moderate group(NIHSS score 7-15 points,n=45),and severe group(NIHSS score>15 points,n=31).Sputum samples of the enrolled patients were collected for sputum culture.The samples with positive results were statistically analyzed for pathogenic bacteria and drug resistance.Results 125 strains of pathogenic bacteria were isolated from sputum samples of all patients,of which 67.20%were Gram-negative bacteria,14.40%were Gram-positive bacteria,and 18.40%were fungi.Pseudomonas aeruginosa infection accounted for the highest proportion(34/125,27.20%).The rate of fungal infection in the severe group was higher than that in the mild group and moderate group(P<0.05).The resistance rate of Gram-negative bacteria to carbapenems(imipenem,meropenem)and quinolones(ciprofloxacin,levofloxacin)was generally low,while the resistance rate to ampicillin,cephalosporin and sulfonamides was high.The resistance rates of Gram-positive bacteria to vancomycin,furantoin and linezolid was low,while the resistance rates to penicillins and quinolones(levofloxacin)was high.The resistance rate of fungi to antibacterial drugs was generally low.Conclusion The pathogenic bacteria in sputum culture of elderly patients with stroke complicated with pulmonary infection are mainly Gram-negative bacteria.The infection rate of fungi is higher than that of gram-positive bacteria,and patients with severe stroke are more susceptible to fungal infections.Multiple drug resistance is common in infected patients,so it is necessary to closely combine with clinical practice,use drugs rationally,effectively deal with infection,and avoid the widespread spread of drug-resistant bacteria.