摘要
目的探讨老年脑卒中(cerebral vascular accident,CVA)患者合并肺部感染的危险因素,并观察临床药师对多重耐药细菌(multiple drug resistant bacteria,MDR)及泛耐药细菌(pan-drug resistance,PDR)感染进行联合会诊的治疗效果。方法将2021年1月至2022年6月期间,襄阳市中心医院收治的300例老年CVA患者作为观察对象,对合并肺内感染的病例进行统计分析,调查其肺部感染相关因素,并观察临床药师参与指导治疗后的临床效果。结果300例老年CVA患者中肺部感染者80例,发生率为26.67%。年龄>70岁,有肺部慢性疾病以及卧床时间≥7 d为老年CVA患者并发肺部感染的独立危险因素(P均<0.05)。通过痰液标本,80例合并肺部感染的老年CVA患者检测出MDR以及PDR合计92株,其中MDR有64例,PDR有26例,合并2种感染10例。MDR主要以大肠埃希菌、金黄色葡萄球菌和阴沟肠杆菌为主,其中大肠埃希菌40.62%(26/64)、金黄色葡萄球菌29.69%(19/64)、阴沟肠杆菌29.69%(19/64);PDR主要以鲍曼不动杆菌和铜绿假单胞菌为主,其中鲍曼不动杆菌50%(13/26)、铜绿假单胞菌50%(13/26)。完全接受临床药师用药意见的患者有75例,占比(93.75%),其中MDR患者58例PDR患者17例;部分接受用药意见4例,占比(5%);未接受用药意见1例,占比(1.25%);总接受率为(98.75%)。58例MDR患者有50例治愈,好转有8例,总有效率为100%;17例PDR患者有15例治愈,好转有2例,总有效率为100%。58例MDR患者中,有52例细菌全部清除,6例患部分清除,总清除率为100%;17例PDR感染患者中,有13例细菌全部清除,3例部分清除,1例患者未清除,总清除率为92.12%。结论高龄、肺部慢性疾病以及长时间卧床等均是导致老年CVA患者引发肺部感染的危险因素,在临床治疗中应针对其存在的高危因素为患者制定有效的预防方案,降低其被感染的几率。临床药师共同参与到患者的临床治疗当中,可为其制订更加科学且有效的耐药菌感染的治疗方案,并为其提供良好的临床药学服务以及药学监护,对MDR和PDR感染的防治以及确保患者生命健康起到尤为重要的作用。
Objective To investigate the risk factors of combined lung infections in elderly patients with Cerebral Vascular Accident(CVA)and to observe the effect of joint consultation with clinical pharmacists on the treatment of multiple drug-resistant bacteria(MDR)and pan-drug resistance(PDR)infections by clinical pharmacists.Methods Three hundred cases of elderly CVA patients admitted to Xiangyang Central Hospital from January 2021 to June 2022 were used as observation subjects,and the cases with combined intrapulmonary infections were counted to investigate the factors related to pulmonary infections,and to observe the clinical effect of the clinical pharmacist’s participation in guiding the treatment after the clinical pharmacist’s participation.Results Out of 300 elderly patients with Cerebral Vascular Accident(CVA),80 cases had pulmonary infections,with an incidence rate of 26.67%.Advanced age(over 70 years),chronic lung disease,and a bed rest duration of 7 days or more were identified as independent risk factors for pulmonary infection in elderly CVA patients(P<0.05).Through sputum specimens,a total of 92 strains of multiple drug-resistant bacteria(MDR)and pan-drug-resistant bacteria(PDR)were detected in 80 elderly CVA patients with pulmonary infections,including 64 cases of MDR and 26 cases of PDR,with 10 cases having dual infections.The MDR strains were primarily Escherichia coli(40.62%,26/64),Staphylococcus aureus(29.69%,19/64),and Enterobacter cloacae(29.69%,19/64);the PDR strains were mainly Acinetobacter baumannii(50%,13/26)and Pseudomonas aeruginosa(50%,13/26).A total of 75 patients fully accepted the medication advice from clinical pharmacists,accounting for 93.75%,including 58 MDR patients and 17 PDR patients;4 cases partially accepted the medication advice,accounting for 5%;and 1 case did not accept the medication advice,accounting for 1.25%,with an overall acceptance rate of 98.75%.Among the 58 MDR patients,50 were cured and 8 improved,with a total effectiveness rate of 100%;among the 17 PDR patients,15 were cured and 2 improved,also with a total effectiveness rate of 100%.Among the 58 MDR patients,52 had complete bacterial clearance and 6 had partial clearance,with a total clearance rate of 100%;among the 17 PDR-infected patients,13 had complete bacterial clearance,3 had partial clearance,and 1 patient had no clearance,resulting in a total clearance rate of 92.12%.Conclusions Advanced age,chronic lung diseases and long-term bed rest are all risk factors for elderly CVA patients to cause pulmonary infection.In clinical treatment,an effective prevention plan should be formulated for patients based on their existing high-risk factors to reduce the chance of infection.The participation of clinical pharmacists in the clinical treatment of patients can formulate more scientific and effective treatment plans for drug-resistant bacteria infections for them,and provide good clinical pharmaceutical services and pharmaceutical monitoring,which plays an especially important role in the prevention and treatment of MDR and PDR infections and ensuring the health of patients.
作者
余露
郑玉兰
杨雪娇
王春花
申梁
YU Lu;ZHENG Yulan;YANG Xuejiao;WANG Chunhua;SHEN Liang(Wuhan University of Science and Technology School of Medicine,430081,China;Department of Respiratory and Critical Care Medicine,Xiangyang Central Hospital,441000,China)
出处
《传染病信息》
2025年第1期42-46,共5页
Infectious Disease Information
基金
湖北省自然基金项目(2022CFB539)。
关键词
老年
脑卒中
肺部感染
危险因素
耐药菌
临床药师
治疗效果
old age
stroke
lung infection
risk factors
drug-resistant bacteria
clinical pharmacist
therapeutic effect
