高龄患者脑卒中后肺炎病原学特点及耐药相关因素分析  

Analysis of Etiology Characteristics and Related Factors of Drug Resistance in Elderly Patients with Post-stroke Pneumonia

作　　者：倪红燕[1,2] 顾慧玲[2] 王海峰[2] 曹卫军[3] 

机构地区：[1]同济大学医学院,上海200092 [2]上海市第一人民医院宝山分院呼吸科,200940 [3]同济大学附属肺科医院呼吸科,200433

出　　处：《医学研究杂志》2017年第8期149-152,共4页Journal of Medical Research

摘　　要：目的探讨高龄患者脑卒中后肺炎病原学特点,分析其耐药相关因素,为临床治疗提供理论依据。方法以2013年9月~2016年9笔者医院收治的154例高龄患者脑卒中后肺炎为研究对象,对痰液标本进行病原学检测及药敏试验,分析其病原学特点及耐药的影响因素。结果 154例痰液标本中,细菌培养阳性率为59.7%,其中革兰阴性菌(G^-)占66.4%、革兰阳性菌(G^+)占29.0%,真菌占2.8%。G^-菌前3位依次是肺炎克雷伯菌(22.4%)、大肠杆菌(18.7%)、铜绿假单胞菌(15.0%)。耐药患者53例,耐药率34.4%。多因素分析显示,年龄、抗生素预防性使用、意识状态均是高龄患者脑卒中后肺炎发生耐药的独立危险因素(P<0.05)。结论高龄患者脑卒中后肺炎以G^-感染为主,且多合并耐药性,临床上应根据病原学特征,选择合适的抗菌药物,加强耐药性监测。Objective To investigate the etiology characteristics and related factors of drug resistance in elderly patients with post - stroke pneumonia, in order to provide more theoretical basis for antimicrobial therapy. Methods Totally 154 patients with post - stroke pneumonia hospitalized in our hospital from September 2013 to September 2016 were selected as the research object. Then the etiological examination was carried out for the sputum specimens. The drug susceptibility testing was conducted, and the etiological characteristics and related factors of drug resistance were analyzed. Results In the 154 sputum specimens, the germiculture positive rate of the speci- mens was 59. 7% , including 66.4% of G - bacteria, 29.0% of G＋ bacteria and 2.8% of fungus. The first three kinds of G bacteria were klebsiellapneumoniae （22.4%） , e. coli （ 18.7% ） , pseudomonas aeruginosa （ 15.0% ）. There were 53 patients of drug resistance with the resistance rate of 34.4%. Multivariate analysis showed that age, preventive use of antibiotics, consciousness in patients with post - stroke pneumonia were independent risk factors for the development of drug - resistant （ P 〈 0.05）. Conclusion G- bacteria infection is the major pathogen in elderly patients with post - stroke pneumonia, and often complicated with drug resistance. We should choose ap- propriate antibacterial drugs, strengthen drug resistance surveillance according to the characteristics of etiology.

关 键 词：脑卒中后肺炎 高龄 病原学特点 耐药 相关因素 

分 类 号：R563.1[医药卫生—呼吸系统]