老年患者多重耐药菌肺部感染危险因素

Risk factors for multidrug-resistant organism pulmonary infection in elderly patients

目的探讨某院老年患者多重耐药菌（MDRO）肺部感染的危险因素,为其防治提供依据。方法采用回顾性调查方法,选取该院2010年8月—2012年12月发生肺部感染的老年患者188例,其中痰细菌培养结果为MDRO感染的患者作为病例组（95例）,非MDRO感染患者作为对照组（93例）,分析两组患者的病历资料。结果老年MDRO肺部感染患者共分离MDRO102株,居前3位的病原菌分别为鲍曼不动杆菌（31.37%）,铜绿假单胞菌（25.49%）及耐甲氧西林金黄色葡萄球菌（15.69%）。单因素分析显示,脑血管病或痴呆病史、低蛋白血症、吞咽困难、长期卧床、重症监护病房（ICU）入住史、使用第三/四代头孢菌素、有创操作7项因素均是老年MDRO肺部感染的危险因素。多因素logistic回归分析显示,低蛋白血症（OR=6.02,95%CI：1.50-24.18）、有创操作（OR=6.55,95%CI：1.69-25.44）、长期卧床（OR=6.03,95%CI：1.92-18.91）均是老年患者发生MDRO肺部感染的独立危险因素。结论老年患者MDRO肺部感染是多种因素共同作用的结果,应针对其危险因素制定综合防治措施,预防和控制老年患者MRDO肺部感染的发生。

Objective To evaluate risk factors for multidrug-resistant organisms（MDRO）pulmonary infection in elderly patients in a hospital,and provide scientific basis for prevention and control of MDRO infection.Methods 188 elderly patients who developed pulmonary infection between August 2010 and December 2012 were divided into MDR group（n=95）and non-MDR group（n=93）according to sputum bacterial culture results,clinical data of two groups of patients were analyzed.Results 102 strains of MDROs were isolated from patients with MDRO pulmonary infection,the top three were Acinetobacter baumannii（31.37%）,Pseudomonas aeruginosa（25.49%）,and methicillin-resistant Staphylococcus aureus（15.69%）.Univariate analysis showed that 7 risk factors for MDRO pulmonary infection in elderly patients were history of cerebrovascular disease or dementia,hypoproteinemia,dysphagia,bedridden,history of ICU hospitalization,recent application of 3,4-generation cephalosporins,and invasive procedures.Multivariate logistic regression analysis showed that hypoproteinemia（OR,6.02[95%CI,1.50-24.18]）,invasive procedures（OR,6.55 [95%CI,1.69-25.44]）,and bedridden（OR,6.03[95%CI,1.92-18.91]）were independent risk factors for MDRO pulmonary infection in elderly patients.Conclusion Multiple factors contribute to MDRO pulmonary infection in elderly patients,comprehensive prevention and control measures should be taken against the risk factors,so as to prevent and control MRDO pulmonary infection in elderly patients.