支架相关性呼吸道感染的发生率和病原学及危险因素分析

Incidence, bacterial spectrum and predictive risk factors for stent associated respiratory tract infection

目的 评价支架相关性呼吸道感染（SARTI）的发生率、病原学特点和危险因素。方法采用巢式病例对照研究方法，前瞻性观察SARTI的发生情况，计算发病率和预测危险因素。通过观察支架置入后1～3个月的呼吸道症状、痰培养、支气管镜检查、镜下保护性毛刷刷检分泌物行细菌和真菌培养、x线胸片等指标变化，以明确疾病诊断，总结SARTI流行病学特点。结果（1）共纳入2011年1月至2015年3月在煤炭总医院呼吸科治疗的满足条件的患者103例。SARTI的发生率为27．2％（28／103）。（2）不同支架类型患者（不锈钢、镍钛记忆合金和硅酮）、不同支架形状患者（直筒、L形和Y形）的SARTI发生率相似；（3）SARTI的病原学主要为金黄色葡萄球菌（14／28）和铜绿假单胞菌（10／28）。发生金黄色葡萄球菌、铜绿假单胞菌和白色念珠菌感染的中位时间分别为7d（4—60d）、53d（15—67d）和63d（28～90d）。（4）logistic回归模型结果显示，女性是减少SARTI发生的保护因素（OR=0．178，P=0．011），而年龄〉50岁是增加风险的危险因素（OR=3．91，P=0．036）。结论约1／4气道支架患者发生SARTI，主要致病菌为金黄色葡萄球菌和铜绿假单胞菌。女性是减少SARTI发生的保护因素，而年龄〉50岁是增加SARTI风险的危险因素。

Objective To evaluate the incidence, bacterial spectrum and predictive risk factors for stent associated respiratory tract infection （SARTI）. Methods A prospective nested case-control study was conducted to evaluate the incidence of SARTI and the predictive risk factors for SARTI. Respiratory symptoms, sputum bacterial culture, electronic bronchoscopy investigation, bacterial culture obtained from protective bronchoscopic brushing, and chest radiographs were evaluated before and after stent implantation. Results （1） Between January, 2011 and March, 2015, a total of 103 patients were included. The incidence of SARTI was 27.2% （ 28/103 ）. （ 2 ） The incidence of SARTI was similar in subgroups with different stent types （metal stent or silicon stent） and different stent shapes （straight, L or Y shape）. （3） Staphylococcus aureus （ 50. 0%, 14/28 ） and Pseudomonas aeruginosa （ 35.7%, 10/28 ） were the dominant pathogens. The infection of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans occurred 7 （4 - 60） days, 53 （ 15 - 67 ） days and 63 （28 - 90） days after stent implantation, respectively. （4） Binary logistical regression model analysis showed that female gender（ OR = 0. 178, P = 0. 011 ） and age below 50 years （ OR = 3.91, P = 0. 036 ） were favorable predictive risk factors for SARTI. Conclusions SARTI occurs in a quarter of the patients. Staphylococcus aureus and Pseudomonas aeruginosa are the dominant pathogens. Female gender and younger age are favorable predictive factors for SARTI.