社区获得性肺炎革兰氏阴性菌感染的影响因素

Influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia

目的探讨社区获得性肺炎(CAP)成年患者革兰氏阴性细菌感染的影响因素。方法选取确诊为社区获得性肺炎的成人患者186例。采集患者痰标本检测致病菌;对患者一般资料进行统计分析。结果186例CAP患者中,60例患者检测出92株细菌,占32.26%;其中革兰氏阳性菌19株(14例),革兰氏阴性菌73株(46例),分别占20.65%和79.35%。46革兰氏阴性菌CAP患者与186例CAP患者在年龄、入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素、CD+4和CD+4/CD+8比值存在显著性差异(P<0.05或P<0.01)。分析显示,入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和CD+4/CD+8比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素(P<0.05或P<0.01)。结论入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和CD+4/CD+8比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素。

Objective To investigate the influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia. Methods 186 adult patients with community acquired pneumonia were selected.The sputum samples were detected for pathogenic bacterium,and their general data were analyzed. Results Among60 patients,92 strains were detected,accounting for 32. 26%. There were 19 strains of gram positive strains（ 14 cases） and 73 strains of gram negative strains（ 46 cases）,accounting for 20. 65% and 79. 35%,respectively. There were significant differences in age,antibiotics use before admission,underlying disease,leukocyte disorder,neutrophile granulocyte,malnutrition,total bilirubin,CD＋4and CD＋4/ CD＋8between gram negative strains infected community acquired pneumonia and total community acquired pneumonia（ P 〈0. 05 or P 〈0. 01）. Logistic regression showed that antibiotics use before admission,underlying disease,leukocyte disorder,neutrophile granulocyte,malnutrition,total bilirubinand CD＋4/ CD＋8were independent influencing factors of infecting gram negative bacteria for adult patients with community acquired pneumonia（ P 〈0. 05 or P 〈0. 01）. Conclusion Antibiotics use before admission,underlying disease,leukocyte disorder,neutrophile granulocyte,malnutrition,total bilirubin and CD＋4/CD＋8are independent influencing factors of infecting gram negative bacteria for adult patients with community acquired pneumonia.