老年卒中相关性肺炎多耐药菌感染病原学与危险因素分析

目的:观察和分析老年卒中相关性肺炎(SAP)多重耐药菌(MDR)感染病原学与危险因素.方法:选取147例老年SAP患者作为研究对象,对其MDR感染的病原菌分布进行回顾性分析,根据否为MDR感染将其分为MDR感染组和非MDR感染组,对两组患者的各项临床相关因素进行回顾性分析.结果:共有78例患者发生MDR感染,感染率为53.1%,在患者的痰标本中共分离出165株MDR病原菌,其中,革兰阴性菌为120株,革兰阳性菌为45株,分别占72.7%和27.3%,主要病原菌种类为铜绿假单胞菌、大肠埃希氏菌、肺炎克雷伯菌,分别占21.8%、17.6%和13.9%;铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶的耐药率达到了100%,对头孢曲松、头孢噻肟、氨曲南的耐药率均超过50%,而对阿米卡星、依替米星、美罗培南的耐药率较低,均低于25%;大肠埃希氏菌对氨苄西林、头孢唑啉、哌拉西林、头孢呋辛、氨苄西林/舒巴坦、左氧氟沙星、环丙沙星、妥布霉素、氨苄西林/舒巴坦的耐药率均超过70%,对美罗培南、亚胺培南的耐药率较低,均低于15%;肺炎克雷伯菌对氨苄西林的耐药率达到100%,妥布霉素、磺胺甲噁唑/甲氧苄啶、头孢唑啉、哌拉西林、头孢呋辛、头孢派酮/舒巴坦、氨苄西林/舒巴坦、哌拉西林/他唑巴坦的耐药率均超过50%,对阿米卡星的耐药率低于25%;鲍曼不动杆菌对米诺环素、磺胺甲噁唑/甲氧苄啶、左氧氟沙星的耐药率低于50%,而对其它抗菌药物的耐药率均高于65%.金黄色葡萄球菌对哌拉西林/他唑巴坦、庆大霉素、莫西沙星、左氧氟沙星、头孢西丁、青霉素G的耐药率均高于60%,对磺胺甲噁唑/甲氧苄啶的耐药率低于25%,未分离出对万古霉素、替考拉宁或利奈唑胺的菌株.MDR感染组和非MDR感染组患者的吞咽困难、意识障碍、肢体瘫痪和近期接受过抗生素治疗情况的差异均有统计学意义;Logistic多元回归分析结果显示,老年SAP患者发生MDR感染与意识障碍情况、吞咽困难和近期接受过抗生素治疗具有相关性.结论:老年SAP患者MDR感染的病原菌分布、耐药性和危险因素具有一定的特征性,临床医生应给予充分的关注和密切的监控,采取有效的干预措施,加强MDR感染的防控工作.

Analysis on the etiology and risk factors of multi drug resistant bacteria infection in elderly patients with stroke associated pneumonia

Objective To observe and analyze the etiology and risk factors of multi drug resistant(MDR)bacteria infection in elderly patients with stroke associated pneumonia (SAP). Methods 147 cases of elderly patients with SAP were selected as the research objects. The distribution of MDR pathogens were analyzed retrospectively. According to whether the MDR pathogens were infected, the patients were divided into the MDR infection group and the non MDR infection group. The clinical related factors of the patients in the two groups were analyzed retrospectively. Results There were 78 cases of patients with MDR infec-tion, the infection rate was 53.1%. In the sputum specimens of the patients with MDR infection, 165 strains of MDR pathogens were isolated, in which the gram negative bacteria were 120 strains and the gram positive bacteria were 45 strains, accounting for 72.7%and 27.3%respectively. The main pathogens were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumo-niae, accounting for 21.8%, 17.6%and 13.9%respectively;The resistance rate of Pseudomonas aeruginosa to sulfamethoxa-zole/trimethoprim reached 100%, the resistance rate to ceftriaxone, aztreonam reached more than 50%, while the resistance rate to amikacin, netilmicin, meropenem was lower, which was lower than 25%;The resistance rate of Escherichia coli to ampicillin, cefazolin, cefuroxime, piperacillin, ampicillin/sulbactam, levofloxacin, ciprofloxacin, tobramycin, ampicillin/sulbactam was more than 70%, while the resistance rate to meropenem or imipenem was lower, which was lower than 15%;The resistance rate of Klebsiella pneumoniae to ampicillin reached 100%, the resistance rate to tobramycin, sulfamethoxazole/trimethoprim, cefazolin, cefuroxime, piperacillin, cefoperazone/sulbactam, ampicillin/sulbactam or piperacillin/tazobactam was more than 50%, while the resistant rate to amikacin was less than 25%;The resistance rate of Acinetobacter baumannii to minocycline, cotrimoxazole or levofloxacin was less than 50%, while the resistance rate to other antimicrobial drug was higher than 65%. The resistance rate of Staphylococcus aureus to piperacillin/tazobactam, gentamicin, levofloxacin, moxifloxacin, cefoxitin or penicillin G was higher than 60%, the resistance rate to sulfamethoxazole/trimethoprim was lower than 25%. No stains resistant to vancomycin, linezolid or teicoplanin were isolated. There were statistically significant differences of difficulty swallowing, conscious disturbance, limb paralysis and recent antibiotic therapy between the patients in the two groups;Logistic regression analysis results that the oc-currence of MDR in elderly patients with SAP was related with difficulty swallowing, conscious disturbance and recent antibiotic therapy. Conclusion The distribution and drug resistance of pathogens and risk factors of MDR infection in elderly patients with SAP has certain characteristics, the clinicians should give sufficient attention and close monitoring and take effective interven-tion measures, to strengthen the prevention and control of MDR infection.