急性脑梗死患者肺部感染病原菌分析及危险因素探讨
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摘要
目的检测急性脑梗死患者肺部感染的病原菌分布和耐药性,并对其感染危险因素进行分析,为临床合理应用抗菌药物以及预防和控制急性脑梗死患者肺部感染发生措施的制定提供参考。方法 2014年1月至2018年5月本院诊治的急性脑梗死并发肺部感染患者317例,对其进行病原学及其耐药性检测。统计患者的年龄、性别,是否患高血压和糖尿病,侵入性操作及意识功能障碍、低蛋白血症、住院时间等信息,进行单因素分析(χ~2检验),P<0.05为肺部感染危险因素。结果 317例急性脑梗死肺部感染患者共培养出病原菌338株,其中革兰阴性菌228株,占67.45%;革兰阳性菌85株,占25.15%;真菌25株,占7.40%。G~-菌中的肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌检出率较高,分别占21.01%、18.05%和13.02%,其对氨苄西林、左氧氟沙星、环丙沙星的耐药率为70.42%～95.77%,对哌拉西林他唑巴坦、头孢哌酮舒巴坦、亚胺培南耐药率为2.82%～9.09%。G~+菌中的表皮葡萄球菌和金黄色葡萄球菌分别占11.54%和10.95%,其对青霉素、苯唑西林、红霉素、莫西沙星、左氧氟沙星的耐药率为35.90%～100.00%,对利奈唑胺、替考拉宁、呋喃妥因、万古霉素耐药率为0。真菌中的白色假丝酵母菌、热带假丝酵母菌分别占4.14%和2.07%,其对氟康唑、伊曲康唑、两性霉素B的耐药率为28.57%～42.86%,对制霉菌素、氟胞嘧啶耐药率为0。单因素分析显示,年龄、患糖尿病、侵入性操作、意识功能障碍、低蛋白血症、住院时间是急性脑梗互患者肺部感染发生的危险因素(P<0.05)。结论急性脑梗死患者肺部感染的发生与年龄、合并糖尿病、侵入性操作、意识功能障碍、低蛋白血症、住院时间等因素有关,感染病原菌菌谱广泛且存在一定的耐药性。因此,开展病原学检查及其耐药性检测并消除相关感染危险因素,对于控制或减少急性脑梗死患者肺部感染的发生及临床合理应用抗菌药物具有重要意义。
Objectives To determine the distribution and drug resistance of pathogens causing a pulmonary infection in patients with acute cerebral infarction and to analyze risk factors in order to provide a reference for rational use of antibiotics in clinical settings and formulation of measures for prevention and control of pulmonary infections in patients with acute cerebral infarction. Methods Subjects were 317 patients with acute cerebral infarction and a pulmonary infection who were treated at this Hospital from January 2014 to May 2018. Pathogens were detected and their drug resistance was determined. Information such as age, sex, whether the patient had hypertension or diabetes mellitus, whether the patient underwent an invasive procedure, impaired consciousness, hypoproteinemia, and the duration of hospitalization was collected and subjected to a univariate analysis(χ~2 test), with P<0.05 indicating a risk factor for development of a pulmonary infection. Results Three hundred and thirty-eight strains of pathogens were cultured from the 317 patients with acute cerebral infarction and a pulmonary infection. Of those, 228(67.45%) were strains of Gram-negative bacteria, 85(25.15%) were strains of Gram-positive bacteria, and 25(7.40%) were strains of fungi. The most prevalent Gram-negative bacteria detected were Klebsiella pneumoniae(21.01%), Pseudomonas aeruginosa(18.05%), and Acinetobacter baumannii(13.02%). Those bacteria were resistant to ampicillin, levofloxacin, and ciprofloxacin at a rate of 70.42-95.77% and to piperacillin, tazobactam, cefoperazone, sulbactam, and imipenem at a rate of 2.82-9.09%. The most prevalent Gram-positive bacteria detected were Staphylococcus epidermidis(11.54%) and S. aureus accounted(10.95%). Those bacteria were resistant to penicillin, oxacillin, erythromycin, moxifloxacin, and levofloxacin at a rate of 35.90-100.00% and to linezolid, teicoplanin, nitrofurantoin, and vancomycin at a rate of 0%. The most prevalent fungi detected were Candida albicans(4.14%) and C. tropicalis(2.07%). Those fungi were resistant to fluconazole, itraconazole, and amphotericin B at a rate of 28.57-42.86% and to nystatin and fluorocytosine at a rate of 0%. Univariate analysis indicated that age, having diabetes mellitus, undergoing an invasive procedure, having impaired consciousness, having hypoproteinemia, and the duration of hospitalization were risk factors for development of a pulmonary infection in patients with acute cerebral infarction(P<0.05). Conclusion In patients with acute cerebral infarction, development of a pulmonary infection was related to factors such as age, having diabetes mellitus, undergoing invasive surgery, having impaired consciousness, having hypoproteinemia, and the duration of hospitalization. A pulmonary infection was caused by a wide range of infectious pathogens, and those pathogens were resistant to antibiotics to an extent. Thus, pathogen testing and drug susceptibility testing should be performed, and risk factors related to the development of an infection should be eliminated. These steps are crucial to controlling or reducing the incidence of a pulmonary infection in patients with acute cerebral infarction and rationally using antibiotics in clinical settings.
Objectives To determine the distribution and drug resistance of pathogens causing a pulmonary infection in patients with acute cerebral infarction and to analyze risk factors in order to provide a reference for rational use of antibiotics in clinical settings and formulation of measures for prevention and control of pulmonary infections in patients with acute cerebral infarction. Methods Subjects were 317 patients with acute cerebral infarction and a pulmonary infection who were treated at this Hospital from January 2014 to May 2018. Pathogens were detected and their drug resistance was determined. Information such as age, sex, whether the patient had hypertension or diabetes mellitus, whether the patient underwent an invasive procedure, impaired consciousness, hypoproteinemia, and the duration of hospitalization was collected and subjected to a univariate analysis(χ~2 test), with P<0.05 indicating a risk factor for development of a pulmonary infection. Results Three hundred and thirty-eight strains of pathogens were cultured from the 317 patients with acute cerebral infarction and a pulmonary infection. Of those, 228(67.45%) were strains of Gram-negative bacteria, 85(25.15%) were strains of Gram-positive bacteria, and 25(7.40%) were strains of fungi. The most prevalent Gram-negative bacteria detected were Klebsiella pneumoniae(21.01%), Pseudomonas aeruginosa(18.05%), and Acinetobacter baumannii(13.02%). Those bacteria were resistant to ampicillin, levofloxacin, and ciprofloxacin at a rate of 70.42-95.77% and to piperacillin, tazobactam, cefoperazone, sulbactam, and imipenem at a rate of 2.82-9.09%. The most prevalent Gram-positive bacteria detected were Staphylococcus epidermidis(11.54%) and S. aureus accounted(10.95%). Those bacteria were resistant to penicillin, oxacillin, erythromycin, moxifloxacin, and levofloxacin at a rate of 35.90-100.00% and to linezolid, teicoplanin, nitrofurantoin, and vancomycin at a rate of 0%. The most prevalent fungi detected were Candida albicans(4.14%) and C. tropicalis(2.07%). Those fungi were resistant to fluconazole, itraconazole, and amphotericin B at a rate of 28.57-42.86% and to nystatin and fluorocytosine at a rate of 0%. Univariate analysis indicated that age, having diabetes mellitus, undergoing an invasive procedure, having impaired consciousness, having hypoproteinemia, and the duration of hospitalization were risk factors for development of a pulmonary infection in patients with acute cerebral infarction(P<0.05). Conclusion In patients with acute cerebral infarction, development of a pulmonary infection was related to factors such as age, having diabetes mellitus, undergoing invasive surgery, having impaired consciousness, having hypoproteinemia, and the duration of hospitalization. A pulmonary infection was caused by a wide range of infectious pathogens, and those pathogens were resistant to antibiotics to an extent. Thus, pathogen testing and drug susceptibility testing should be performed, and risk factors related to the development of an infection should be eliminated. These steps are crucial to controlling or reducing the incidence of a pulmonary infection in patients with acute cerebral infarction and rationally using antibiotics in clinical settings.
引文
[1] Meng X, Wen R, Li X. Values of serum LDL and PCT levels in evaluating the condition and prognosis of acute cerebral infarction[J] Exp Ther Med,2018,16(4):3065-9.
[2] 胡浩,田龙,赵玉洁.老年急性脑血管疾病患者肺部感染的病原菌分布与药敏分析[J].中华医院感染学杂志,2016,26(7):1520-2.
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[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科学杂志,2015,48(4):246-57.
[6] Perl T, Quintel M. Nosocomial pneumonia. Prevention and diagnostic[J]. Anaesthesist,2011,60(3):236-42.
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[8] Griffiths C, Drews SJ, Marchant DJ.Respiratory syncytial virus: infection, detection, and new options for prevention and treatment[J]. Clin Microbiol Rev,2017,30(1):277-319.
[9] Tu J, Wang LX, Wen HF, et al. The association of different types of cerebral infarction with post-stroke depression and cognitive impairment[J]. Medicine(Baltimore),2018,97(23):e10919.
[10] Pavlakis SG, Roach ES. Silent cerebral infarction: Not so silent after all[J]. Neurology,2018,90(3):105-6.
[11] Thanachartwet V, Wattanathum A, Sahassananda D, et al. Dynamic measurement of hemodynamic parameters and cardiac preload in adults with dengue: a prospective observational study[J]. PLoS One,2016,11(5):e0156135.
[12] 牛勇爱,潘邑水,刘锦峰,等.脑梗死患者肺部感染危险因素与病原菌分析[J].中华医院感染学杂志,2015,25(14):3161-3.
[13] 任开涵,赵义,张芳,等.老年心血管病并发肺炎人群临床特点与病原菌的耐药性探讨[J].中国卫生检验杂志,2018,28(8):938-40.
[14] 张瑜,贺利锋,汤永国,等.急性脑梗死老年患者肺部感染的病原学特征及影响因素分析[J].中华医院感染学杂志,2018,28(13):1947-50.
[15] 宋铃铃,张新蔚,冀磊,等.急性脑卒中并发肺部感染的相关因素及病原菌特点分析[J].中国卫生检验杂志,2018,28(10):1247-9.
[16] Hori YS, Kodera S, Sato Y, et al. Eosinopenia as a predictive factor of the short-term risk of mortality and infection after acute cerebral infarction[J]. J Stroke Cerebrovasc Dis,2016,25(6):1307-12.
[17] 王文利,段海平,刘碧原,等.急性脑卒中患者肺部感染的病原菌特点及危险因素分析[J].中华医院感染学杂志,2017,27(11):2465-8.
[2] 胡浩,田龙,赵玉洁.老年急性脑血管疾病患者肺部感染的病原菌分布与药敏分析[J].中华医院感染学杂志,2016,26(7):1520-2.
[3] Li L, Zhang LH, Xu WP, et al. Risk assessment of ischemic stroke associated pneumonia[J]. World J Emerg Med,2014,5(3):209-13.
[4] 宋扬,臧大维,汪志云,郭洁,等.急性脑梗死患者肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(16):3645-7.
[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科学杂志,2015,48(4):246-57.
[6] Perl T, Quintel M. Nosocomial pneumonia. Prevention and diagnostic[J]. Anaesthesist,2011,60(3):236-42.
[7] 中华人民共和国卫生部医政司.全国临床检验操作规程[M]. 4版.北京:人民卫生出版社,2015:636-8.
[8] Griffiths C, Drews SJ, Marchant DJ.Respiratory syncytial virus: infection, detection, and new options for prevention and treatment[J]. Clin Microbiol Rev,2017,30(1):277-319.
[9] Tu J, Wang LX, Wen HF, et al. The association of different types of cerebral infarction with post-stroke depression and cognitive impairment[J]. Medicine(Baltimore),2018,97(23):e10919.
[10] Pavlakis SG, Roach ES. Silent cerebral infarction: Not so silent after all[J]. Neurology,2018,90(3):105-6.
[11] Thanachartwet V, Wattanathum A, Sahassananda D, et al. Dynamic measurement of hemodynamic parameters and cardiac preload in adults with dengue: a prospective observational study[J]. PLoS One,2016,11(5):e0156135.
[12] 牛勇爱,潘邑水,刘锦峰,等.脑梗死患者肺部感染危险因素与病原菌分析[J].中华医院感染学杂志,2015,25(14):3161-3.
[13] 任开涵,赵义,张芳,等.老年心血管病并发肺炎人群临床特点与病原菌的耐药性探讨[J].中国卫生检验杂志,2018,28(8):938-40.
[14] 张瑜,贺利锋,汤永国,等.急性脑梗死老年患者肺部感染的病原学特征及影响因素分析[J].中华医院感染学杂志,2018,28(13):1947-50.
[15] 宋铃铃,张新蔚,冀磊,等.急性脑卒中并发肺部感染的相关因素及病原菌特点分析[J].中国卫生检验杂志,2018,28(10):1247-9.
[16] Hori YS, Kodera S, Sato Y, et al. Eosinopenia as a predictive factor of the short-term risk of mortality and infection after acute cerebral infarction[J]. J Stroke Cerebrovasc Dis,2016,25(6):1307-12.
[17] 王文利,段海平,刘碧原,等.急性脑卒中患者肺部感染的病原菌特点及危险因素分析[J].中华医院感染学杂志,2017,27(11):2465-8.
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