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。
Objective To explore the characteristics of pathogenic bacteria and risk factors for stroke‐associated pneumonia （SAP） in senile patients in order to privide basis for early clinical intervention .Methods A retrospective study was carried out to review the clinical data of 689 SAP patients treated at a university hospital between January 1 ,2011 and December 12 ,2013 . The pathogens from sputum and their antibiotic resistance profiles were analyzed .Multivariate Logistic regression model was used to screen relevant factors for stroke‐associated pneumonia （SAP） in a case‐control analysis at 1∶1 ratio .Results Of the 684 bacterial strains isolated from sputum , 545 （79 .7% ） were gram‐negative bacteria . The top bacterial species were Pseudomonasaeruginosa,Klebsiellapneumoniae,Acinetobacterbaumannii,and Enterobacterspp.Gram‐negativebacteria were highly resistant to most of the antimicrobial agents . About 31 .8% of the Acinetobacter strains were resistant to imipenem .A total of 139 （20 .3% ） gram‐positive strains were isolated . Staphylococcus aureus was the most frequently isolated gram‐positive pathogen （51 .8% ） , of which 63 .9% were resistant to methicillin （MRSA） .Most gram‐positive bacteria were sensitive to vancomycin , teicoplanin and linezolid . Multivariate Logistic regression suggested that age （ OR = 5 .632 ） , NIH stroke scale （NIHSS） score （OR= 4 .126） ,dysphagia （OR= 3 .481） , totally bedridden （OR=3 .431） ,mechanical ventilation （OR=4 .214） ,hyperglycemia （OR=2 .076） ,hypoalbuminemia （OR=2 .008） ,and high serum cortisol （OR=1 .825） were the major risk factors for SAP in senile patients .Conclusions Multiple antibiotic‐resistant pathogens are usually identified in the senile SAP patients .Early intervention to control the risk factors of SAP is important for prevention of SAP in senile patients .
出处
《中国感染与化疗杂志》
CAS
北大核心
2014年第6期508-513,共6页
Chinese Journal of Infection and Chemotherapy
基金
上海市杨浦区卫生计生系统"百医登高计划"项目
关键词
老年
卒中相关性肺炎
病原菌
危险因素
senile patient
stroke-associated pneumonia
pathogenic bacteria
risk factor
