老年医疗护理相关性肺炎多重耐药菌感染的影响因素及预后

Evaluating risk factors for multidrug-resistant pathogens and outcomes in elderly patients with healthcareassociated pneumonia

目的考察影响老年医疗护理相关性肺炎（heahhcare—associatedpneumonia，HcAP）多重耐药（muhidrug—resistance，MDR）菌感染及预后的因素。方法前瞻性收集2007年1月至2012年1月间因HCAP住院、年龄≥65岁患者的下呼吸道、血、胸水等标本，行病原学鉴定，观察MDR比例，Logistic回归筛选与MDR感染及死亡相关的危险因素。结果286例获得病原学诊断患者中，MDR感染121例（42．3％）。在HCAP定义的各种危险因素中，90d内住院、家庭医疗护理、病情危重和前期应用抗生素为MDR感染的独立危险因素。死亡与患者年龄、家庭护理／医疗护理机构居住、肺炎严重指数、简易急性生理评分Ⅱ、未及时抗生素治疗密切相关，而与MDR感染及是否依从指南选择抗生素治疗无关。结论MDR感染仅占老年HCAP的一部分，且与患者死亡无必然的联系。HCAP定义的各种危险因素在预测MDR感染时差别较大，应探索更有效的方法评估HCAP中MDR的感染。

Objective To assess risk factors of infection due to multidrug-resistant （MDR） pathogens and outcomes among elderly patients with healthcare-associated pneumonia （HCAP）. Methods A prospective study was conducted in consecutive patients hospitalized with HCAP, aged ~65 years old, from January 2007 to January 2012. Sample of the lower respiratory tract （sputum and bronchoalveolar lavage fluid） ,serum and pleural effusion were collected and detected for MDR. Logistic regression models were used to evaluate independent risk factors for acquiring MDR bacteria and inhospital mortality. Results Among the 286 patients, a total of 121 （42.3N） MDR pathogens were recovered. Of all risk factors, hospitalization in the preceding 90 days, prior antibiotics therapy, intensive care unit admission and residency in a nursing home were independent predictors for infection with MDR pathogens. Age,pneumonia severity index, simplified acute physiology score l][ and residency in a nursing home were also independent predictors for inhospital mortality, but MDR and nonadherence to guidline were not associated with mortality. Conclusions MDR pathogens account partly for HCAP among elderly patients,and are not associated with mortality. The pratical roles of risk factors included in the HCAP definition are considerably different in predicting infection due to MDR bacteria and outcomes, and a probabilistic method to identify MDR pathogens among patients with HCAP should be explored.