CAJ | 학술논문

目的：探讨老年卒中相关性肺炎（SAP）的病原菌特点及其危险因素，为临床早期干预提供指导。方法采用回顾性研究，对2011年1月至2013年12月同济大学附属杨浦医院住院的689例SAP患者的痰液标本资料进行整理分析，了解老年SAP患者痰液病原菌构成情况及耐药性特点。对SAP患者给予1∶1配比对照组，分析老年SAP发生的相关危险因素。结果采集到的684株痰菌标本中，革兰阴性菌545株（79．7％），主要分离菌依次为铜绿假单胞菌、肺炎克雷伯菌、不动杆菌属和肠杆菌属。革兰阴性菌对多数抗菌药物有高耐药率，其中不动杆菌对亚胺培南的耐药率高达31．8％；革兰阳性菌139株（20．3％），以金黄色葡萄球菌（金葡菌）为主，占革兰阳性菌的51．8％，甲氧西林耐药金葡菌（M RSA ）占金葡菌63．9％。革兰阳性菌对万古霉素、替考拉宁和利奈唑胺敏感性较高。多因素Logistic回归分析显示，老年SAP发病的主要危险因素有：年龄（OR＝5．632），美国国立卫生院脑卒中量表（NIHSS）评分（OR＝4．126），吞咽困难（OR＝3．481），卧床（OR＝3．431），机械通气（OR＝4．214），合并高血糖（OR＝2．076）、低白蛋白血症（OR＝2．008）、高皮质醇水平（OR＝1．825）。结论老年SAP常合并多种耐药菌感染，其发生、发展有多种高危因素参与，临床需加强早期预防。
목적：탐토노년졸중상관성폐염（SAP）적병원균특점급기위험인소，위림상조기간예제공지도。방법채용회고성연구，대2011년1월지2013년12월동제대학부속양포의원주원적689례SAP환자적담액표본자료진행정리분석，료해노년SAP환자담액병원균구성정황급내약성특점。대SAP환자급여1∶1배비대조조，분석노년SAP발생적상관위험인소。결과채집도적684주담균표본중，혁란음성균545주（79．7％），주요분리균의차위동록가단포균、폐염극뢰백균、불동간균속화장간균속。혁란음성균대다수항균약물유고내약솔，기중불동간균대아알배남적내약솔고체31．8％；혁란양성균139주（20．3％），이금황색포도구균（금포균）위주，점혁란양성균적51．8％，갑양서림내약금포균（M RSA ）점금포균63．9％。혁란양성균대만고매소、체고랍저화리내서알민감성교고。다인소Logistic회귀분석현시，노년SAP발병적주요위험인소유：년령（OR＝5．632），미국국립위생원뇌졸중량표（NIHSS）평분（OR＝4．126），탄인곤난（OR＝3．481），와상（OR＝3．431），궤계통기（OR＝4．214），합병고혈당（OR＝2．076）、저백단백혈증（OR＝2．008）、고피질순수평（OR＝1．825）。결론노년SAP상합병다충내약균감염，기발생、발전유다충고위인소삼여，림상수가강조기예방。
Objective To explore the characteristics of pathogenic bacteria and risk factors for stroke‐associated pneumonia (SAP) in senile patients in order to privide basis for early clinical intervention .Methods A retrospective study was carried out to review the clinical data of 689 SAP patients treated at a university hospital between January 1 ,2011 and December 12 ,2013 . The pathogens from sputum and their antibiotic resistance profiles were analyzed .Multivariate Logistic regression model was used to screen relevant factors for stroke‐associated pneumonia (SAP) in a case‐control analysis at 1∶1 ratio .Results Of the 684 bacterial strains isolated from sputum , 545 (79 .7% ) were gram‐negative bacteria . The top bacterial species were Pseudomonasaeruginosa,Klebsiellapneumoniae,Acinetobacterbaumannii,and Enterobacterspp.Gram‐negativebacteria were highly resistant to most of the antimicrobial agents . About 31 .8% of the Acinetobacter strains were resistant to imipenem .A total of 139 (20 .3% ) gram‐positive strains were isolated . Staphylococcus aureus was the most frequently isolated gram‐positive pathogen (51 .8% ) , of which 63 .9% were resistant to methicillin (MRSA) .Most gram‐positive bacteria were sensitive to vancomycin , teicoplanin and linezolid . Multivariate Logistic regression suggested that age ( OR = 5 .632 ) , NIH stroke scale (NIHSS) score (OR= 4 .126) ,dysphagia (OR= 3 .481) , totally bedridden (OR=3 .431) ,mechanical ventilation (OR=4 .214) ,hyperglycemia (OR=2 .076) ,hypoalbuminemia (OR=2 .008) ,and high serum cortisol (OR=1 .825) were the major risk factors for SAP in senile patients .Conclusions Multiple antibiotic‐resistant pathogens are usually identified in the senile SAP patients .Early intervention to control the risk factors of SAP is important for prevention of SAP in senile patients .