Abstract:

Objective　To investigate the pathogenic bacteria, drug resistance, and antibiotic use in elderly patients with cerebral infarction and pulmonary infection. Methods　A total of 222 elderly patients with cerebral infarction admitted to the Third People's Hospital of Liaocheng from January to June 2023 were selected as the study subjects, including 137 males and 85 females, aged 60-85 (71.39±5.47) years. Their morning sputum from deep respiratory tract was collected to identify the pathogenic bacteria by the VITEK^®2 Compact system, and the drug resistance was tested by the K-B method. The use of antibiotics was analyzed. Results　Among the 222 elderly patients with cerebral infarction, 60 patients developed pulmonary infection, with an incidence of 27.03%. A total of 136 strains of pathogenic bacteria were isolated from the 60 patients, including 27 (19.85%) strains of Gram-positive bacteria, 104 (76.47%) strains of Gram-negative bacteria, and 5 (3.68%) strains of fungi. The main Gram-positive bacteria had high resistance to erythromycin, penicillin, and ampicillin, but low resistance to linezolid, vancomycin, nitrofurantoin, tigecycline, and tetracycline. Among the main Gram-negative bacteria, Klebsiella pneumoniae had low resistance to cefepime, cefotetan, tobramycin, ceftazidime, cefazolin, and piperacillin; E. coli had high resistance to amikacin, ceftazidime, levofloxacin, piperacillin, ciprofloxacin, gentamicin, and cefazolin, but low resistance to cefuroxime, cefotetan, and piperacillin/tazobactam; Pseudomonas aeruginosa had high resistance to piperacillin/tazobactam and cefazolin, but low resistance to amikacin, cefepime, tobramycin, imipenem, levofloxacin, and cefotetan. Among the 60 patients, 55 were treated with antibiotics alone, accounting for 91.67%. Among the antibiotics used, cephalosporins, compound preparations, and quinolones were used most frequently, and the main drugs were piperacillin/tazobactam, levofloxacin, and ceftizoxime. Conclusions　Gram-negative bacteria such as Klebsiella pneumoniae, E. coli, and Pseudomonas aeruginosa are main pathogenic bacteria in the sputum of elderly patients with cerebral infarction and pulmonary infection, which are highly resistant to some commonly used drugs. Identification of pathogenic bacteria and drug sensitivity test can help effectively prevent and treat pulmonary infection in elderly patients with cerebral infarction in clinical practice.

Key words:

Elderly, Cerebral infarction, Pulmonary infection, Pathogenic bacteria, Drug resistance, Antibiotic use

摘要：

目的　探究老年脑梗死患者伴肺部感染的病原菌、耐药性及抗菌药物使用情况。方法　选择2023年1月至2023年6月聊城市第三人民医院收治的222例老年脑梗死患者，其中男性137例，女性85例，年龄60～85（71.39±5.47）岁。采集呼吸道深部晨痰，经VITEK^®2 Compact系统鉴定病原菌，使用K-B法进行耐药性检测，并分析抗菌药物使用情况。结果　222例老年脑梗死患者中，有60例发生肺部感染，肺部感染发生率为27.03%。60例患者共培养分离病原菌136株，其中革兰阳性菌27株（19.85%）、革兰阴性菌104株（76.47%）、真菌5株（3.68%）。主要革兰阳性菌对红霉素、青霉素、氨苄西林耐药率高，对利奈唑胺、万古霉素、呋喃妥因、替加环素、四环素耐药率低。主要革兰阴性菌中，肺炎克雷伯菌对头孢吡肟、头孢替坦、妥布霉素、头孢他啶、头孢唑林、哌拉西林耐药率低；大肠埃希菌对阿米卡星、头孢他啶、左氧氟沙星、哌拉西林、环丙沙星、庆大霉素、头孢唑林耐药率高，对头孢呋辛、头孢替坦、哌拉西林/他唑巴坦耐药率低；铜绿假单胞菌对哌拉西林/他唑巴坦、头孢唑林耐药率高，对阿米卡星、头孢吡肟、妥布霉素、亚胺培南、左氧氟沙星、头孢替坦耐药率低。60例患者中55例单用抗菌药物，占91.67%，其中头孢菌素类抗生素、复方制剂、喹诺酮类抗生素使用频次最高，主要使用药物以哌拉西林/他唑巴坦、左氧氟沙星、头孢唑肟最多。结论　老年脑梗死伴肺部感染患者痰液中的病原菌以肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌等革兰阴性菌为主，对部分常用药物的耐药性较高，病原菌鉴定和药敏分析有助于临床老年脑梗死伴肺部感染的有效防治。

关键词:

老年, 脑梗死, 肺部感染, 病原菌, 耐药性, 抗菌药物使用