Analysis Of Risk Factors For Stroke-associated Pneumonia And The Distribution Of Pathogenic Bacteria And Drug Resistance In A Shandong Area

ObjectiveBy studying the distribution and drug resistance of the risk factors and pathogens of stroke associated pneumonia(SAP),the risk factors of infection can be detected and avoided as early as possible,laying a foundation for its clinical prevention and treatment and rational application of antibiotics.MethodsThe clinical data of 342 stroke patients admitted to Liaocheng Third People’s Hospital from January 2015 to December 2019 were retrospectively analyzed.According to whether they were complicated with stroke-related pneumonia,these patients were divided into two groups,SAP group(n=158)and non-SAP group(n=184).The clinical data of the two groups were compared.It included gender,stroke history,age,drinking history,smoking history,swallowing disorders,tracheal intubation,mechanical ventilation,consciousness disorders,pulmonary diseases,hypertension,heart diseases,endocrine diseases,etc.Binary Logistic regression analysis was used to further study the possible pathogenesis and independent risk factors of SAP.Pathogen species(gram-positive bacteria,Gram-negative bacteria and fungi)and drug resistance were measured by analyzing pathogen distribution and drug susceptibility in SAP patients.Results(1)There were significant differences in age,stroke history,dysphagia,tracheal intubation,mechanical ventilation and consciousness disorder between SAP group and non-SAP group(P<0.05).Age(OR=2.216,95%CI=1.299-3.831,P=0.004),history of stroke(OR=4.279,95%CI=1.794-11.344,P=0.002),disturbance of consciousness(OR=1.931,95%CI=1.547-2.31,P=0.001),dysphagia(OR=0.008,95%CI=0.0001-0.103,P=0.003)were independent risk factors for SAP.(2)A total of 132 strains of pathogenic bacteria were cultured from 158 SAP patients,including 101 Gram-negative bacilli(76.52%),24 Gram-positive cocci(18.18%)and 7 fungi(5.30%).The top Gram-negative bacteria were Klebsiella pneumoniae(21.21%),Escherichia coli(17.42%),Pseudomonas aeruginosa(13.64%)and Acinetobacter baumannii(11.36%).Staphylococcus aureus(11.36%),Staphylococcus haemolyticus(3.79%)and Staphylococcus epidermidis(1.52%)were the top gram-positive bacteria.The top fungi were Candida albicans(3.03%)and Candida tropicalis(1.52%).In the overall distribution of pathogenic bacteria,the first is Klebsiella pneumoniae pneumonia subspecies.(3)Among gram-negative bacteria,Klebsiella pneumoniae showed strong insensitivity to ampicillin,and high resistance rate to amoxicillin clavulanate,ceftriaxone,etc.,but significantly low insensitivity to carbapenems.The resistance rate index of E.coli to ampicillin is more than 80%,the resistance rate of ceftriaxone,compound sulfamethoxazole and ciprofloxacin is about 50%～80%,and the insensitivity of E.coli to carbapenems is relatively low.Pseudomonas aeruginosa showed strong insensitivity to tigacycline,ampicillin,amoxicillin clavulanate,ceftriaxone,ertapenem and compound sulfamethoxazole,but was more sensitive to piperacillin/tazobactam.The resistance rate of Acinetobacter baumannii to the monitored antibiotics was higher,and the sensitivity to tigacycline was higher.(4)Gram-positive bacteria were highly sensitive to quinupristin,etc.The resistance of S.aureus to antibiotics such as penicillin,erythromycin and clindamycin were above 60%,among which 3 strains of methicillin-resistant S.aureus(MRSA)were isolated and obtained,with an isolation rate of 20%;2 strains of methicillin-resistant coagulase-negative staphylococci(MRCNS)were isolated from S.epidermidis,and 2 strains of S.haemolyticus were isolated Two strains of MRCNS were isolated.(5)Pseudomonas albicans was sensitive to 5-fluorocytosine,etc.,and the resistance rate of Pseudomonas tropicalis to fluconazole and itraconazole was 50%.ConclusionThe occurrence of stroke-related pneumonia is closely related to the patient’s age,history of stroke,dysphagia,and disturbance of consciousness.More attention should be paid to the elderly patients,patients with history of stroke,dysphagia,and disturbance of consciousness,and timely clinical guidance should be given.SAP pathogenic bacteria are mainly Gram-negative bacteria,and there are different degrees of drug resistance.