老年卒中相关性肺炎患者的病原菌特点及危险因素研究

发布时间：2018-05-31 21:08

本文选题：老年 + 卒中相关性肺炎　；参考：《中国感染与化疗杂志》2014年06期

【摘要】：目的探讨老年卒中相关性肺炎(SAP)的病原菌特点及其危险因素,为临床早期干预提供指导。方法采用回顾性研究,对2011年1月至2013年12月同济大学附属杨浦医院住院的689例SAP患者的痰液标本资料进行整理分析,了解老年SAP患者痰液病原菌构成情况及耐药性特点。对SAP患者给予1∶1配比对照组,分析老年SAP发生的相关危险因素。结果采集到的684株痰菌标本中,革兰阴性菌545株(79.7%),主要分离菌依次为铜绿假单胞菌、肺炎克雷伯菌、不动杆菌属和肠杆菌属。革兰阴性菌对多数抗菌药物有高耐药率,其中不动杆菌对亚胺培南的耐药率高达31.8%;革兰阳性菌139株(20.3%),以金黄色葡萄球菌(金葡菌)为主,占革兰阳性菌的51.8%,甲氧西林耐药金葡菌(MRSA)占金葡菌63.9%。革兰阳性菌对万古霉素、替考拉宁和利奈唑胺敏感性较高。多因素Logistic回归分析显示,老年SAP发病的主要危险因素有:年龄(OR=5.632),美国国立卫生院脑卒中量表(NIHSS)评分(OR=4.126),吞咽困难(OR=3.481),卧床(OR=3.431),机械通气(OR=4.214),合并高血糖(OR=2.076)、低白蛋白血症(OR=2.008)、高皮质醇水平(OR=1.825)。结论老年SAP常合并多种耐药菌感染,其发生、发展有多种高危因素参与,临床需加强早期预防。
[Abstract]:Objective to investigate the pathogenic bacteria characteristics and risk factors of stroke associated pneumonia (SAP) in the elderly and to provide guidance for early clinical intervention. Methods the sputum samples of 689 SAP patients hospitalized in Yangpu Hospital affiliated to Tongji University from January 2011 to December 2013 were analyzed retrospectively to understand the pathogenic bacteria composition and drug resistance in the sputum of elderly patients with SAP. The patients with SAP were given 1:1 matched control group to analyze the risk factors related to the occurrence of SAP in the elderly. Results among the 684 sputum specimens, 545 Gram-negative strains were identified as Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter spp. And Enterobacter spp. The main isolates were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter spp. Gram-negative bacteria have high drug resistance to most antimicrobial agents, and Acinetobacter has a high resistance rate to imipenem as high as 31.8.The Gram-positive bacteria 139 strains (20. 3%) are mainly Staphylococcus aureus (Staphylococcus aureus). 51.8% of Gram-positive bacteria, MRSAs of methicillin-resistant Staphylococcus aureus accounted for 63.9% of Staphylococcus aureus. Gram-positive bacteria were sensitive to vancomycin, teicoplanin and linazolamine. Multivariate Logistic regression analysis showed that the main risk factors for the onset of SAP in the elderly were as follows: age OR 5.632, stroke scale of the National Institutes of Health (NHS) = 4.126, dysphagia OR3.481, bed rest ORP 3.431, mechanical ventilation OR4.21414, hyperglycemia OR2.07676, hypoalbuminemia OR2.008, and high cortisol level 1.825g. Conclusion elderly SAP is often complicated with multidrug resistant bacteria infection and its occurrence and development involve many high risk factors. Early prevention should be strengthened in clinical practice.
【作者单位】：同济大学附属杨浦医院老年科;同济大学医学院全科医学系;复旦大学附属华山医院;
【基金】：上海市杨浦区卫生计生系统“百医登高计划”项目
【分类号】：R563.19

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