糖尿病合并肺部感染的急性脑梗死老年患者病原菌分布及耐药性分析  

Analysis of pathogenic bacteria distribution and drug resistance in elderly patients with acute cerebral infarction with diabetes mellitus complicated with pulmonary infection

作　　者：陈蓉 谢忠莲 朱璐 CHEN Rong;XIE Zhonglian;ZHU Lu(Department of Internal Medicine,Guanghan People′s Hospital,Guanghan Sichuan 618300,China)

机构地区：[1]广汉市人民医院大内科,四川广汉618300

出　　处：《新疆医科大学学报》2023年第8期1051-1055,共5页Journal of Xinjiang Medical University

基　　金：四川省卫生和计划生育委员会办公室2021年科研课题项目(21PJ012)。

摘　　要：目的探讨急性脑梗死合并或不合并糖尿病患者发生肺部感染时的病原菌分布及耐药性差异。方法选择2016年1月至2020年12月广汉市人民医院收治的1093例脑梗死患者为研究对象,其中152例在确诊后2~7 d检出肺部感染,根据是否合并糖尿病,将患者分为糖尿病组(n=60)和非糖尿病组(n=92),送检合格痰标本208份,检测感染病原菌及耐药性。结果(1)送检合格痰标本208份,检出病原菌172株,病原菌检出率为82.7%。糖尿病组患者中检测出62株革兰氏阴性菌,11株革兰氏阳性菌和2株真菌。非糖尿病组检测出57株革兰氏阴性菌,34株革兰氏阳性菌和6株真菌。与非糖尿病组比较,糖尿病组革兰氏阴性菌比例更高(χ^(2)=11.336,P=0.001),革兰氏阳性菌比例明显较低(χ^(2)=9.098,P=0.003),真菌培养比例差异无统计学意义(χ^(2)=1.181,P=0.277)。但两组患者的感染菌种无明显差异,革兰氏阴性菌中均以鲍曼不动杆菌、铜绿假单胞菌最常见,革兰氏阳性菌中均以金黄色葡萄球菌、肺炎链球菌最常见。(2)糖尿病组革兰阴性菌耐药率为68.3%,革兰氏阳性菌耐药率为45.0%。非糖尿病组革兰氏阴性菌耐药率为48.9%,革兰氏阳性菌耐药率为28.2%。两组培养过程中均未发现耐药真菌。糖尿病组革兰氏阴性菌和革兰氏阳性菌耐药率均高于非糖尿病组(P<0.05)。结论急性脑梗死合并糖尿病患者发生院内肺部感染的病原菌以多药耐药革兰氏阴性杆菌更为常见。在使用抗生素前应尽快进行病原菌培养,并根据药敏结果合理使用抗菌药物。Objective To investigate the pathogenic bacteria distribution and drug resistance in patients with acute cerebral infarction complicated with or without diabetes mellitus.MethodsA total of 1093 patients with cerebral infarction admitted to Guanhan People′s Hospital from January 2016 to December 2020 were selected as the research subjects.152 patients were detected pulmonary infection 2-7 days after the diagnosis.The patients were divided into diabetes group(n=60)and non-diabetic group(n=92).208 qualified sputum samples were sent for detection of the pathogenic bacteria and drug resistance.Results(1)208 qualified sputum samples were submitted,and the detection rate of the pathogenic bacteria was 82.7%.62 strains of Gram-negative bacteria,11 strains of Gram-positive bacteria and 2 strains of fungi were detected in diabetic patients.57 strains of Gram-negative bacteria,34 strains of Gram-positive bacteria and 6 strains of fungi were detected in the non-diabetic group.Compared with non-diabetic group,the proportion of Gram-negative bacteria in diabetic group was significantly higher(χ^(2)=11.336,P=0.001),and the proportion of Gram-positive bacteria was significantly lower(χ^(2)=9.098,P=0.003),and the difference in the proportion of fungal culture was not statistically significant(χ^(2)=1.181,P=0.277).Among Gram-negative bacteria,Acinetobacter baumannii and pseudomonas aeruginosa were the most common,while among Gram-positive bacteria,Staphylococcus aureus and Streptococcus pneumoniae were the most common.(2)The drug resistance rate of Gram-negative bacteria and Gram-positive bacteria was 68.3%and 45.0%respectively.The drug resistance rate of Gram-negative bacteria and Gram-positive bacteria was 48.9%and 28.2%,respectively.No drug-resistant fungi were found in both groups.The drug resistance rates of Gram-negative bacteria and Gram-positive bacteria in diabetes group were higher than those in non diabetes group(P<0.05).ConclusionIn patients with acute cerebral infarction complicated with diabetes mellitus,the pat

关 键 词：急性脑梗塞 糖尿病 肺部感染 耐药性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]