目的 探讨急性脑卒中患者下呼吸道多重耐药菌感染的危险因素.方法 选择2016年1月至2018年4月在西安医学院第二附属医院就诊的602例急性脑卒中患者作为研究对象.翻阅患者病历资料,记录患者的一般情况、个人史、既往史、卒中性质、卒中部位、发病至住院时间、入院途径、格拉斯哥昏迷评分(GCS)、机械通气、低蛋白血症、抑酸药物应用、吞咽困难、手术治疗、鼻饲置管、应用抗生素、吸痰等资料,观察上述资料与多重耐药菌感染发生的相关性.结果 602例脑卒中患者,其中114例发生下呼吸道感染菌中有61例患者发生下呼吸道多重耐药菌感染;单因素分析显示,抑酸药物应用、吸烟、高血压、卒中位置、尿管、外科手术史、饮酒、过敏史不是影响急性脑卒中患者下呼吸道多重耐药菌感染的危险因素(P>0.05),鼻饲置管、高脂血症、吞咽困难、低蛋白血症、发病至入院时间、性别、慢性阻塞性肺疾病、体质量指数、糖尿病、年龄、卒中性质、GCS评分、前期碳青霉烯类药物、ICU住院时间、机械通气、手术治疗是影响急性脑卒中患者下呼吸道多重耐药菌感染的危险因素(P<0.05);多因素二分类Logistic回归分析结果显示,年龄>75岁、前期碳青霉烯类抗生素应用、吞咽障碍、院外转入、ICU住院时间≥72 h、机械通气>7 d是影响急性脑卒中下呼吸道多重耐药菌感染的独立危险因素(P<0.05),GCS≥9分是急性脑卒中下呼吸多重耐药菌感染的保护性因素(P<0.05).结论 急性脑卒中患者下呼吸道多重耐药菌感染是多因素综合作用的结果,临床应注意根据危险因素进行针对性防控以减少多重耐药菌的发生.

目的:探讨肺炎球菌DNA负荷(LytA基因)、降钙素原(PCT)和可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平与肺炎链球菌感染患者病情严重程度的相关性.方法:选择184例肺炎链球菌感染患者作为研究对象,按照病情严重程度将患者分为轻度组(71例)、中度组(68例)和重度组(45例).采用定量荧光PCR反应测定血液LytA基因,采用酶联免疫吸附法(ELISA法)检测血浆suPAR水平,采用量免疫色谱法检测PCT水平,根据肺炎严重指数评分对患者病情进行分度.观察LytA、PCT及suPAR水平与疾病严重程度的相关性.结果:3组患者LytA阳性率相比较差异无统计学意义(F=1.900,P>0.05);LytA、PCT及suPAR水平随着病情分度增加逐渐升高,3组比较差异均有统计学意义(F=62.057,F=73.892,F=48.509;P<0.05).相关性分析显示,LytA、PCT及suPAR水平与病情严重程度均呈显著正相关(r=0.472,r=0.506,r=0.438;P<0.05);LytA与PCT、suPAR水平呈显著正相关(r=0.603,r=0.682;P<0.05).结论:肺炎链球菌肺炎患者血液中lytA、PCT及suPAR水平与病情严重程度均呈显著正相关;LytA基因量与PCT、suPAR水平呈显著正相关.

Objective To analyze the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP), and to study the prognosis of patients infected with CRKP.Methods One hundred and fifteen patients with K.pneumoniae hospital infection were selected from January 2012 to December 2015 in the present study.Bacterial culture, identification and drug sensitivity test were carried out;then these 115 patients were divided into the CRKP group (53 cases) and non-CRKP group (62 cases) according to the results of drug sensitivity test, and prognosis of them were observed and analyzed.Results ①One hundred and sixty-four strains of K.pneumoniae were isolated from the 115 patients, and they were distributed in different specimens such as 48 strains (29.3%) in the sputum, 37 strains (22.6%) in the blood, 26 strains (15.9%) in the drainage liquid, 22 strains (13.4%) in the Pus, 15 strains (9.1%) in the bile, 9 strains (5.5%) in the urine and 7 strains (4.3%) in the wound secretion.②K.Pneumoniae isolated from 53 patients were identified as the CRKP (75 strains), and that isolated from the other 62 patients were identified as the non-CRKP (89 strains).The resistance rate of K.Pneumoniae: it was more than 95% to ampicillin, amoxicillin/clavulanate, cefalotin, cefotaxime, aztreonam, meropenem, gentamicin and ciprofloxacin.But that was less than 50% to tetracycline, tigecycline, minocycline, sulfamethoxazole and trimethoprim, fosfomycin.The resistance rate of K.Pneumoniae to piperacillin/tazobactam, imipenem and ertapenem were in 80%~90%.③Compared with the non-CRKP group, the hospitalization days after infection[(64±22) days], hospital mortality (23%) and infection related mortality (32%) of patients in the CRKP group were obviously higher (P<0.05), but the total effective rate (55%) were significantly lower (P<0.05).ConclusionK.pneumoniae are widely distributed in sputum of patients with infection, and CRKP has a high drug resistance to most antibiotics that used in clinical practice commonly.So patients infected with CRKP suffered a poor prognosis but a high fatality rate.