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来源：蜘蛛抓取(WebSpider) 时间：2017-11-02 17:22 标签： 平邑郑成
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老年阿尔茨海默病患者肺部感染的病原菌分布及危险因素分析
目的 分析阿尔茨海默病患者中阿尔茨海默病合并肺部感染的病原菌分布、耐药性及相关危险因素,为临床老年阿尔茨海默病患者的预后提供参考依据.方法 选取2010年7月-2016年2月医院收治的老年阿尔茨海默病合并肺部感染痰培养阳性患者66例,对患者进行细菌培养及药敏试验,分析感染患者的病原菌分布、耐药性及相关感染影响因素.结果 66例痰培养阳性患者共分离病原菌106株,其中革兰阴性菌82株,占77.36％,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主,分别占38.68％、11.32％、11.32％,革兰阳性菌18株,占16.98％,以金黄色葡萄球菌、沃式葡萄球菌为主,分别占6.60％和4.72％,真菌6株,占5.66％;革兰阴性菌对亚胺培南、美罗培南的耐药率均＜9.00％,革兰阳性菌对万古霉素耐药率为0;单因素及多因素分析结果显示,年龄＞70岁、伴有糖尿病、长时间卧床、住院时间＞1个月、较长的病程时间及伴有吸烟史均是引发阿尔茨海默病合并肺部感染的危险因素.结论 老年阿尔茨海默病合并肺部感染患者除了肺部功能降低外,还可导致慢性脑部缺氧性疾病,脑皮质血管受损,大脑对呼吸的调控能力下降,也是细菌不易从肺部清除的重要原因;对于老年阿尔茨海默病合并肺部感染者的病原菌分布、耐药性及感染危险因素的分析,对患者的预后具有重要的临床意义.
Abstract：
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing pulmonary infections in patients with Alzheimer's disease and analyze the related risk factors so as to provide guidance for prognosis of the patients with Alzheimer's disease.METHODS A total of 66 Alzheimer's disease patients complicated with pulmonary infections who were treated in the hospital from Jul 2010 to Feb 2016 were enrolled in the study.The bacterial culture and drug susceptibility testing were carried out for the patients,the distribution and drug resistance of the pathogens isolated from the patients with infections were observed,and the related risk factors for the infections were analyzed.RESULTS Totally 106 strains of pathogens were isolated from the 66 patients,of which 82 (77.36％) were gram-negative bacteria,18 (16.98％) were gram-positive bacteria,and 6 (5.66％)Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa were dominant among the gram-negative bacteria,accounting for 38.68 ％,11.32 ％,and 11.32 ％,Staphylococcus aureus and Staphylococcus warneri were the predominant species of the gram-positive bacteria,accounting for 6.60％ and 4.72％,respectively.The drug resistance rates of the gram-negative bacteria to imipenem and meropenem were less than 9.00％,and the drug resistance rates of the gram-positive bacteria to vancomycin was 0.The results of univariate analysis and multivariate analysis indicated that the risk factors for the pulmonary infections in the patients with Alzheimer's disease included the more than 70 years of age,complication with diabetic mellitus,long bedridden time,length of hospital stay more than 1 month,long disease course,and smoking history.CONCLUSION The complication with pulmonary infections may reduce the lung function of the patients with Alzheimer's disease and result in chronic brain hypoxia diseases,cerebral cortical vascular damage,and decline of brain's ability to regulate the breathing as well,which is also the leading cause of the bacteria not to be easily removed from the lungs.It is of great clinical significance for the prognosis of patients with Alzheimer's disease to investigate the distribution and drug resistance of the pathogens causing the pulmonary infection and analyze the risk factors.
WANG He-bin
ZHANG Ying-zhong
LIAN Guo-min
ZHENG Cheng-ying
作者单位：
宁波市康宁医院老年科,浙江宁波,315201
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浙江省医药卫生科技计划基金资助项目
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