重症肺部感染患者降阶梯抗菌治疗失败的影响因素分析

Influencing Factors of Down- ladder Antibiotic Therapy Failure in Patients with Severe Pulmonary Infection

目的分析重症肺部感染患者降阶梯抗菌治疗失败的影响因素。方法选取2013年2月—2016年2月惠州市第三人民医院收治的重症肺部感染患者250例,收集患者的临床资料,分析重症肺部感染患者降阶梯抗菌治疗失败的影响因素。结果 250例患者中降阶梯抗菌治疗失败65例(26.0%),成功185例(74.0%)。降阶梯抗菌治疗失败患者与降阶梯抗菌治疗成功患者性别、机械通气率、深静脉置管率、深静脉置管时间、用药方案比较,差异无统计学意义(P>0.05);降阶梯抗菌治疗失败患者与降阶梯抗菌治疗成功患者年龄、清蛋白水平、机械通气时间、多重耐药菌感染发生率、抗菌药物不合理使用率比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄〔OR=15.386,95%CI(10.215,26.143)〕、清蛋白水平〔OR=2.364,95%CI(1.380,4.128)〕、机械通气时间〔OR=2.124,95%CI(1.132,3.683)〕、多重耐药菌感染〔OR=6.892,95%CI(4.165,8.714)〕是重症肺部感染患者降阶梯抗菌治疗失败的影响因素(P<0.05)。结论年龄、清蛋白水平、机械通气时间、多重耐药菌感染是重症肺部感染患者降阶梯抗菌治疗失败的影响因素。

Objective To analyze the influencing factors of down- ladder antibiotic therapy failure in patients with severe pulmonary infection. Methods A total of 250 patients with severe pulmonary infection were selected in the Third People＇s Hospital of Huizhou from February 2013 to February 2016,their clinical data was collected,and influencing factors of down-ladder antibiotic therapy failure in patients with severe pulmonary infection were analyzed. Results Of the 250 patients,65cases（ accounting for 26. 0%） with down- ladder antibiotic therapy failure were served as A group, other 185 cases（ accounting for 74. 0%） without down- ladder antibiotic therapy failure were served as B group. No statistically significant differences of gender,mechanical ventilation ratio,deep vein catheterization ratio,duration of deep vein catheterization or drug programs was found between the two groups（ P〉0. 05）,while there were statistically significant differences of age,albumin,duration of mechanical ventilation, inidence of multi- drug resistant bacterial infection and unreasonable utilization ratio of antibacterial agents between the two groups（ P〈0. 05）. Multivariate logistic regression analysis showed that, age 〔OR =15. 386,95% CI（ 10. 215, 26. 143） 〕, albumin 〔OR = 2. 364, 95% CI（ 1. 380, 4. 128） 〕, duration of mechanical ventilation 〔OR = 2. 124,95% CI（ 1. 132,3. 683） 〕 and multi- drug resistant bacterial infection 〔OR = 6. 892,95% CI（ 4. 165,8. 714） 〕were influencing factors of down- ladder antibiotic therapy failure in patients with severe pulmonary infection（ P〈0. 05）. Conclusion Age,albumin,duration of mechanical ventilation and multi- drug resistant bacterial infection are influencing factors of down- ladder antibiotic therapy failure in patients with severe pulmonary infection.