2021 年第 9 期 第 16 卷

急性脑卒中合并糖尿病患者肺部感染的病原菌分布和耐药性以及多重耐药的影响因素分析

Analysis of pathogenic bacterias distribution, drug resistance and influencing factors of multidrug resistance of pulmonary infection in patients with acute stroke complicated with diabetes mellitus

作者：宋斌斌蒋艳钱粉红

英文作者：Song Binbin Jiang Yan Qian Fenhong

单位：江苏大学附属医院呼吸与危重症医学科，江苏省镇江市212000

英文单位：Department of Respiratory and Critical Care Medicine Affiliated Hospital of Jiangsu University Jiangsu Province Zhenjiang 212000 China

关键词：脑卒中；糖尿病；肺部感染；药物敏感试验；多重耐药

英文关键词：Stroke；Diabetesmellitus；Pulmonaryinfection；Drugresistancetest；Multidrugresistance

• 摘要：

• 目的 探讨急性脑卒中合并糖尿病患者肺部感染的病原菌分布、耐药性以及发生多重耐药的影响因素。方法 回顾性分析江苏大学附属医院2017年6月至2020年12月收治的95例急性脑卒中合并肺部感染患者的临床资料，根据是否合并糖尿病将95例患者分为糖尿病组（44例）及非糖尿病组（51例）。患者入院后均进行痰培养查找病原菌，并进行药物敏感试验。比较2组病原菌检出情况及其耐药率，以及急性脑卒中合并肺部感染患者发生多重耐药的影响因素。结果 糖尿病组共检出91株病原菌，其中革兰阴性菌62株、金黄色葡萄球菌15株、白色念珠菌14株；非糖尿病组共检出81株病原菌，其中革兰阴性菌66株、革兰阳性菌7株、白色念珠菌8株。糖尿病组革兰阴性菌对哌拉西林舒巴坦、庆大霉素、妥布霉素、环丙沙星的耐药率均高于非糖尿病组［21.6%(8/37)比6.1%（3/49），40.5%(15/37)比16.3%（8/49），24.3%(9/37)比6.1%（3/49），54.1%(20/37)比24.5%（12/49）］，革兰阳性菌对青霉素的耐药率高于非糖尿病组［100%(15/15)比3/7］（均P＜0.05）。Logistic回归分析结果显示，住院时间（比值比=2.199,95%置信区间：1.365~3.542，P=0.001）和美国国立卫生研究院卒中量表（NIHSS）评分（比值比=1.124,95%置信区间：1.032~1.255，P=0.007）是急性脑卒中合并肺部感染患者出现多重耐药菌的独立危险因素。结论 本院急性脑卒中合并肺部感染患者，无论是否合并糖尿病，痰培养检出的病原菌均以革兰阴性菌为主，糖尿病组病原菌对主要抗菌药物的耐药率高于非糖尿病组。住院时间和NIHSS评分是急性脑卒中合并肺部感染患者出现多重耐药菌的危险因素。

• Objective To investigate the pathogenic bacterias distribution, drug resistance and influencing factors of multidrug resistance of pulmonary infection in patients with acute stroke complicated with diabetes mellitus. Methods Clinical data of 95 patients with acute stroke complicated with pulmonary infection admitted to Affiliated Hospital of Jiangsu University from June 2017 to December 2020 were retrospectively analyzed. According to whether patients have diabetes mellitus, 95 patients were divided into diabetic group (44 cases) and non-diabetic group (51 cases). After admission, sputum culture was carried out to find pathogenic bacterias and drug sensitivity test was carried out. The detection and drug resistance rate of pathogenic bacterias, as well as the influencing factors of multidrug resistance in patients with acute stroke complicated with pulmonary infection were compared between the two groups. Results A total of 91 strains of pathogenic bacterias were detected in diabetic group, including 62 strains of Gram-negative bacterias, 15 strains of Staphylococcus aureus and 14 strains of Candida albicans; a total of 81 strains of pathogenic bacterias were detected in non-diabetic group, including 66 strains of Gram-negative bacterias, 7 strains of Gram-positive bacterias and 8 strains of Candida albicans. The resistance rates of Gram-negative bacterias to piperacillin/sulbactam, gentamicin, tobramycin and ciprofloxacin in diabetic group were higher than those in non-diabetic group ［21.6%(8/37) vs 6.1%(3/49), 40.5%(15/37) vs 16.3%(8/49), 24.3%(9/37) vs 6.1%(3/49), 54.1%(20/37) vs 24.5%(12/49)］, and the resistance rate of Gram-positive bacterias to penicillin in diabetic group was higher than that in non-diabetic group ［100% (15/15) vs 3/7］(all P<0.05). Logistic regression analysis showed that length of stay (odds ratio = 2.199, 95% confidence interval: 1.365-3.542, P=0.001) and National Institutes of Health Stroke Scale (NIHSS) score (odds ratio=1.124, 95% confidence interval: 1.032-1.255, P=0.007) were independent risk factors for multidrug resistance bacterias in patients with acute stroke complicated with pulmonary infection. Conclusions In the patients with acute stroke complicated with pulmonary infection in our hospital, Gram-negative bacterias are the main pathogenic bacterias detected in sputum culture whether they were complicated with diabetes mellitus or not. The drug resistance rates of pathogens to main antibacterials in the diabetic group are higher than those in the non-diabetic group. The length of stay and NIHSS score were the risk factors of multidrug resistance bacterias in patients with acute stroke complicated with pulmonary infection.