摘要
目的分析老年急性脑卒中患者并发医院感染的病原体分布、耐药性及影响因素。方法选取我院自2015年1月-2017年12月收治的660例老年急性脑卒中患者临床资料进行回顾性分析,统计感染率、病原体、耐药性及影响因素。结果 660例老年急性脑卒中患者中发生医院感染116例,占17.58%,老年急性脑卒中并发医院感染中,以呼吸道感染和泌尿系感染为主。感染的病原体为革兰阳性菌、革兰阴性菌和真菌,革兰阴性菌以大肠埃希菌和克雷伯菌属为主,革兰阳性菌以粪肠球菌和表皮葡萄球菌为主。感染常见革兰阴性菌、革兰阳性菌对多种抗生素存在不同程度耐药。年龄、意识障碍、侵入性操作、机械通气、糖尿病、低蛋白血症、住院时间是老年急性脑卒中发生医院感染的独立危险因素(P<0.05)。结论老年急性脑卒中发生医院感染的病原体为革兰阳性菌、革兰阴性菌和真菌,革兰阴性菌以大肠埃希菌和克雷伯菌属为主,对医院常用抗生素存在不同程度耐药,临床中应结合感染情况及耐药情况选择适合的抗生素;年龄、意识障碍、侵入性操作、机械通气、糖尿病、低蛋白血症、住院时间是老年急性脑卒中发生医院感染的独立危险因素,对存在独立危险因素的患者应做好预防措施,减少感染的发生。
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infection in elderly patients with acute stroke and analyze the influencing factors.METHODS The clinical data of 660 elderly patients with acute stroke who were treated in the hospital from Jan 2015 to Dec 2017 were retrospectively analyzed.The incidence of infection,species of pathogens,drug resistance rates and influencing factors were statistically analyzed.RESULTS Of the 660 elderly patients with acute stroke,116 had nosocomial infection,accounting for 17.58%.The patients with respiratory tract infection and urinary tract infection were dominant among the elderly acute stroke patients complicated with nosocomial infection.The gram-positive bacteria,gram-negative bacteria and fungi were the pathogens causing the infection;Escherichia coli and Klebsiella were dominant among the gram-positive bacteria;Enterococcus faecalis and Staphylococcus epidermidis were the predominant species of gram-negative bacteria.The gram-negative bacteria and gram-positive bacteria causing the infection varied in the drug resistance to multiple antibiotics.The age,disturbance of consciousness,invasive operation,mechanical ventilation,diabetes mellitus,hypoproteinemia and length of hospital stay were the independent risk factors for the nosocomial infection in the elderly patients with acute stroke（P〈0.05）.CONCLUSIONS The gram-positive bacteria,gram-negative bacteria and fungi are the pathogens causing the nosocomial infection in the elderly patients with acute stroke.E.coli and Klebsiella are dominant among the gram-positive bacteria and vary in the drug resistance to the commonly used antibiotics.It is necessary for the hospital to reasonably use antibiotics based on the prevalence of infection and drug resistance.The age,disturbance of consciousness,invasive operation,mechanical ventilation,diabetes mellitus,hypoproteinemia and length of hospital stay are the independent risk factors for the nosocomial infection in the elderly patients with acute stroke.It is necessary to take effective prevention measures for the independent risk factors so as to reduce the incidence of infection.
作者
琚小红
陈晨
刘晗睿
段圣杰
胡晓雁
王琛
JU Xiao-hong;CHEN Chen;LIU Han-rui;DUAN Sheng-jie;HU Xiao-ya;WANG Chen(Heji Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046011,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第21期3226-3229,3233,共5页
Chinese Journal of Nosocomiology
基金
山西省医学会临床科研资金资助项目(2017ZYC-A40)
关键词
老年人
急性脑卒中
医院感染
病原体
耐药性
影响因素
Elderly
Acute stroke
Nosoeomial infection
Pathogen
Drug resistance
Influencing factor
