类风湿关节炎住院患者肺部感染病原学及影响因素

Etiology and influencing factors of pulmonary infection in hospitalized patients with rheumatoid arthritis

目的分析类风湿关节炎(Rheumatoid arthritis, RA)住院患者肺部感染的病原学特征及影响因素,为医院感染的预防和控制工作提供研究依据。方法选取2014年1月-2019年12月的415例RA住院患者作为研究对象,对其合并肺部感染情况、病原学特征及感染影响因素进行回顾性分析。结果有45例患者确诊合并肺部感染,感染率为10.84%,在33例患者的痰样本检出病原菌,检出率为73.33%,检出33株病原菌,革兰阳性菌8株占24.24%,以金黄色葡萄球菌为主;革兰阴性菌13株占39.39%,以肺炎克雷伯菌为主;真菌12株占36.36%,以白假丝酵母为主。Logistic多元回归模型多因素分析结果显示,RA患者合并肺部感染的发生与病程、应用糖皮质激素、应用抗风湿药物(Disease Modifying Anti-rheumatic Drugs, DMARDs)具有相关性(P<0.05)。结论导致RA住院患者肺部感染的病原菌以革兰阴性菌、真菌为主,其感染风险与病程及药物治疗因素有关,临床医生应采取有效措施加强RA住院患者的医院感染防控工作,以达到改善患者预后的目的。

OBJECTIVE To analyze the pathogenic characteristics and influencing factors of pulmonary infection in hospitalized patients with rheumatoid arthritis(RA), so as to provide research basis for the prevention and control of nosocomial infection. METHODS Total of 415 hospitalized patients with RA from Jan. 2014 to Dec. 2019 were recruited as the study subjects. The occurrence, the pathogenic characteristics and the influencing factors of pulmonary infection in the patients were analyzed retrospectively. RESULTS Forty-five patients were diagnosed with pulmonary infection, with the infection rate of 10.84%. In 33 patients’ sputum samples, pathogenic bacteria were detected, the detection rate was 73.33%. Thirty-three strains of pathogenic bacteria were detected, in which, 8 strains were Gram-positive bacteria, accounting for 24.24%, mainly including Staphylococcus aureus;13 strains were Gram-negative bacteria, accounting for 39.39%, mainly including Klebsiella pneumoniae;12 strains were fungi, accounting for 36.36%, mainly including Candida albicans. The results of multivariate Logistic regression model showed that the incidence of pulmonary infection in RA patients was correlated with the course of disease, the application of glucocorticoids and the application of disease modifying anti-rheumatic drugs(DMARDs)(P<0.05). CONCLUSION Gram-negative bacteria and fungi are the main pathogens of pulmonary infection in patients with RA. The risk of infection is related to the course of disease and factors of drug treatment. The clinicians should take effective measures to strengthen the prevention and control of nosocomial infection in patients with RA, in order to improve the prognosis of patients.