心内科住院患者肺部感染的病原菌分布及危险因素分析

Analysis of distribution and risk factors of pathogens causing pulmonary infections to patients in cardiology department

目的探讨心内科住院患者肺部感染的病原菌分布及危险因素,为预防心内科住院患者肺部感染提供临床依据。方法分析医院心内科2010年6月-2012年6月1 308例住院患者肺部感染的发生率及病原学分布,调查患者的一般资料,分析心内科住院患者发生肺部感染的危险因素;采用SPSS 18.0软件进行统计分析,采用χ2检验和logistic回归模型进行危险因素的单因素分析和多因素分析。结果 1 308例患者共发生肺部感染137例,感染率为10.47%,其中上呼吸道感染61例占44.53%,下呼吸道感染76例占55.47%;共分离出病原菌137株,其中革兰阳性菌45株占32.85%;革兰阴性菌76株占55.47%;真菌16株占11.68%,排前3位的病原菌依次为金黄色葡萄球菌、铜绿假单胞菌和嗜麦芽寡养单胞菌,分别占16.06%、13.87%、11.68%;年龄、侵入性操作、机械通气、ICU停留、肺部感染史、卧床时间、血清白蛋白低及抗菌药物使用种类均为心内科住院患者肺部感染的高危因素(P<0.01)。结论心内科住院患者肺部感染的发生率较高,且下呼吸道感染的比例稍高,主要病原菌为革兰阴性菌、其次为革兰阳性菌,真菌较少;该类患者发生肺部感染的危险因素较多,应针对高危因素进行预防干预。

OBJECTIVE To explore the distribution of pathogens causing pulmonary infections to patients in cardiology department and the relevant risk factors so as to provide clinical evidence for preventing pulmonary infections suffered by patients in department of cardiology.METHODS The pulmonary infection rate and pathogen distribution of the 1308cases of patients in cardiology department from Jun 2010to Jun 2012were analyzed,the general data of those patients were investigated,and logistic regression model was employed to analyze the risk factors for pulmonary infections.SPSS 18.0software was adopted for statistical analysis;Chi-square test and logistic regression model were adopted for single factor analysis and multiple-factor analysis of risk factors.RESULTS Among 1308cases,there were a total of 137cases suffering pulmonary infections,with infection rate of 10.47%;61cases of patients suffered upper respiratory tract infections and 76cases suffered lower respiratory tract infections,accounting for 44.53% and 55.47%respectively.Among them,there were 45strains of gram-positive bacteria,76 strains of gram-negative bacteria and 16strains of fungi respectively,which accounted for 32.85%,55.47% and 11.68% among the 137strains of isolated pathogens.The top three pathogens were Staphylococcus aureus, Pseudomonas aeruginosa and Stenotrophomonas maltophilia successively,accounting for 16.06%,13.87% and 11.68%respectively;so,the patients′age,invasive procedures,mechanical ventilation,ICU stay,history of pulmonary infection,time in bed,low serum albumin and types of antibiotic use were all the risk factors causing pulmonary infections（P＆lt;0.01）.CONCLUSIONThe incidence of pulmonary infections among the patients of cardiology department is high,and the lower respiratory infection rate is high;the main pathogens are gram-negative bacteria,followed by gram-positive bacteria and fungi;and there are many risks factors causing pulmonary infection, so it is necessary to take preventive measures for high risk factors.