First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Medicine (Baltimore). 2023 Sep 8;102(36):e35023. doi: 10.1097/MD.0000000000035023.
Stroke patients may have dysphagia and frequent aspiration increasing exposure to antibiotics and the chance of multidrug-resistant (MDR) bacteria infection. This study investigated clinical risk factors and related antibiotic use of MDR bacteria infection in stroke patients in the rehabilitation ward, hoping that it can help prevent and reduce the condition of MDR bacteria. A retrospective cohort study was conducted using the database of stroke patients with pneumonia admitted to the rehabilitation ward from January 1, 2020, to June 30, 2022. The selected stroke patients were divided into the MDR and non-MDR groups. Analyze the infection bacteria of the 2 groups. Forward logistic regression was applied to identify possible independent MDR bacteria infection risk factors. A total of 323 patients were included. The top 3 common MDR pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Almost all Pseudomonas aeruginosa and Acinetobacter baumannii are resistant to ertapenem. National Institute of Health stroke scale at admission was associated with MDR bacteria infection pneumonia (OR [odds ratio] = 1.078, 95%CI [1.017, 1.142]). Long-term tracheotomy (OR = 2.695, 95%CI [1.232, 5.897]), hypoalbuminemia (OR = 473, 95%CI [1.318, 4.642]), and bilateral cerebral hemisphere stroke (OR = 4.021, 95%CI [2.009, 8.048]) were significant clinical risk factors of MDR pneumonia after stroke. The detection rate of MDR bacteria has increased. Understanding the distribution and drug resistance of MDR bacteria in stroke patients with pneumonia in the neurological rehabilitation ward and the related susceptibility of MDR bacteria infection is necessary. This way, the treatment plan can be adjusted more timely, avoiding the abuse of antibiotics.
脑卒中患者可能存在吞咽困难和频繁误吸，增加了接触抗生素的机会和多重耐药（MDR）细菌感染的机会。本研究旨在探讨神经内科康复病房脑卒中患者发生 MDR 细菌感染的临床危险因素及相关抗生素使用情况，以期帮助预防和减少 MDR 细菌的发生。采用回顾性队列研究方法，收集 2020 年 1 月 1 日至 2022 年 6 月 30 日神经内科康复病房收治的肺炎脑卒中患者的数据库资料，将所选脑卒中患者分为 MDR 组和非 MDR 组。分析 2 组感染细菌，采用向前逐步 logistic 回归分析筛选可能存在的独立 MDR 细菌感染危险因素。共纳入 323 例患者，前 3 位常见 MDR 病原体分别为铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌，几乎所有铜绿假单胞菌和鲍曼不动杆菌对厄他培南均耐药。入院时美国国立卫生研究院卒中量表评分与 MDR 细菌感染性肺炎相关（OR=1.078，95%CI[1.017，1.142]）。长期气管切开（OR=2.695，95%CI[1.232，5.897]）、低蛋白血症（OR=473，95%CI[1.318，4.642]）、双侧大脑半球脑卒中（OR=4.021，95%CI[2.009，8.048]）是脑卒中后 MDR 肺炎的独立危险因素。MDR 细菌的检出率有所增加。了解神经内科康复病房脑卒中合并肺炎患者 MDR 细菌的分布及耐药情况和 MDR 细菌感染的相关易感性，有利于及时调整治疗方案，避免抗生素滥用。
