全身麻醉手术老年患者肺部感染病原菌和耐药性及血清TLR4、sTREM-1、CRP/PAB的预测价值

Distribution and drug resistance of pathogens from elderly general anesthesia patients with pulmonary infection and predictive values of serum TLR4,sTREM-1 and CRP/PAB

目的探讨老年全身麻醉手术患者肺部感染病原菌、耐药性及血清Toll样受体4(TLR4)、可溶性髓系细胞触发受体-1(sTREM-1)、C-反应蛋白(CRP)/前清蛋白(PAB)的预测价值。方法选取2021年8月-2023年8月重庆东南医院收治的101例全身麻醉手术后发生肺部感染老年患者为研究组,选择同期122例于医院全身麻醉手术后未发生肺部感染老年患者为对照组。分析老年全身麻醉手术患者肺部感染的病原菌特点及耐药性,比较两组血清TLR4、sTREM-1、CRP/PAB水平,并分析上述指标诊断老年全身麻醉手术后患者发生肺部感染的价值。结果101例老年全身麻醉手术后肺部感染患者共检出病原菌112株,其中革兰阴性菌检出85株(75.89%)。主要革兰阴性菌中铜绿假单胞菌、肺炎克雷伯菌对头孢曲松耐药率较高,分别为76.60%、45.45%,而对其余抗菌药物耐药率较低。与对照组比,研究组血清TLR4、sTREM-1、CRP/PAB水平更高(P<0.05)。血清TLR4、sTREM-1、CRP/PAB联合检测诊断老年全身麻醉手术后患者发生肺部感染的曲线下面积(AUC)值为0.922,高于三指标单一检测(P<0.05)。结论革兰阴性菌为老年全身麻醉手术患者肺部感染的主要致病菌,不同病原菌的耐药特点不同,血清TLR4、sTREM-1、CRP/PAB在老年全身麻醉手术后肺部感染患者中呈高表达,且三者联合检测的诊断价值更高。

OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from the elderly general anesthesia patients with pulmonary infection and analyze the predictive values of serum Toll-like receptor 4(TLR4),soluble triggering receptor expressed on myeloid cells(sTREM-1)and C-reactive protein(CRP)/prealbumin(PAB).METHODS A total of 101 elderly patients who underwent general anesthesia surgery and had postoperative pulmonary infection in Chongqing Southeast Hospital from Aug.2021 to Aug.2023 were assigned as the study group,meanwhile,122 elderly patients who underwent general anesthesia surgery but did not have postoperative pulmonary infection were chosen as the control group.The distribution and drug resistance of pathogens isolated from the patients with pulmonary infection were observed.The levels of serum TLR4,sTREM-1 and CRP/PAB were compared between the two groups,and the values of the above indexes in diagnosis of the postoperative pulmonary infection in the elderly patients were analyzed.RESULTS Totally 112 strains of pathogens isolated from the 101 elderly general anesthesia patients with postoperative pulmonary infection,85(75.89%)of which were gram-negative bacteria.Pseudomonas aeruginosa and Klebsiella pneumoniae were the predominant species of the gram-negative bacteria,and the drug resistance rates of the two species to ceftriaxone were 76.60%and 45.45%,respectively,while the drug resistance rates to other antibiotics were low.The levels of serum TLR4,sTREM-1 and CRP/PAB of the study group were significantly higher than those of the control group(P<0.05).The area under the curve(AUC)of the joint detection of serum TLR4,sTREM-1 and CRP/PAB was 0.922 in diagnosis of the postoperative pulmonary infection in the elderly general anesthesia patients,significantly higher than that of the single detection(P<0.05).CONCLUSIONS The gram-negative bacteria are the predominant pathogens isolated from the elderly general anesthesia patients with postoperative pulmonary infection.The pathogens vary in drug resistance.The elderly patients with postoperative pulmonary infections show high expressions of serum TLR4,sTREM-1 and CRP/PAB.The diagnostic value of the joint detection of the three indexes is higher than that of the single detection.