带状疱疹继发感染的病原学特点及危险因素分析

Etiological characteristics of herpes zoster patients with secondary infection and analysis of risk factors

目的分析带状疱疹继发感染的病原学特点及危险因素,为临床预防和治疗提供参考依据。方法选取医院2014年12月-2016年9月收治的带状疱疹患者953例,统计病原菌分布及分析带状疱疹继发感染的危险因素。结果 87例带状疱疹继发感染患者共分离培养出病原菌84株,其中革兰阴性菌64株占76.2%,革兰阳性菌17株占20.2%,真菌3株占3.6%;肺炎克雷伯菌对庆大霉素、阿米卡星、美罗培南耐药率分别为85.7%、80.9%、95.2%,铜绿假单胞菌对庆大霉素、阿米卡星、美罗培南耐药率分别为66.7%、83.3%、88.9%,大肠埃希菌对庆大霉素、阿米卡星、美罗培南耐药率分别为60.0%、93.3%、100.0%,表皮葡萄球菌对红霉素、青霉素、万古霉素耐药率分别为83.3%、66.7%、66.7%,金黄色葡萄球菌对红霉素、青霉素、万古霉素耐药率分别为80.0%、80.0%、60.0%,凝固酶阴性葡萄球菌对红霉素、青霉素、万古霉素耐药率分别为80.0%、60.0%、100.0%;单因素分析显示,带状疱疹继发感染与年龄≥50岁、皮损面积≥500cm2、未接受规范治疗及有水痘带状疱疹病毒接触史具有相关性(P<0.05);多因素logistic回归分析结果显示,年龄≥50岁、皮损面积≥500cm2、未接受规范治疗为带状疱疹继发感染的独立危险因素。结论革兰阴性菌为带状疱疹继发感染的主要病原菌,年龄≥50岁、皮损面积≥500cm2、未接受规范治疗为带状疱疹继发感染的危险因素,针对病原菌特点和危险因素,采取相应措施,是降低带状疱疹继发感染的关键。

OBJECTIVE To investigate the etiological characteristics of herpes zoster patients with secondary infection and analyze the risk factors so as to provide guidance for clinical prevention and treatment.METHODS A total of 953 patients with herpes zoster who were treated in the hospital from Dec 2014 to Sep 2016 were enrolled in the study.The distribution of pathogens was statistically analyzed,and the risk factors for secondary infection in the herpes zoster patients were observed.RESULTS Totally 84 strains of pathogens were isolated from the 87 herpes zoster patients with secondary infection,including 64（76.2%）strains of gram-negative bacteria,17（20.2%）strains of gram-positive bacteria,and 3（3.6%）strains of fungi.The drug resistance rates of Klebsiella pneumoniae strains to gentamicin,amikacin,and meropenem were 85.7%,80.9%,and 95.2%,respectively;the drug resistance rates of Pseudomonas aeruginosa strains to gentamicin,amikacin,and meropenem were 66.7%,83.3%,and 88.9%,respectively;the drug resistance rates of Escherichia coli strains to gentamicin,amikacin,and meropenem were 60.0%,93.3%,and 100.0%,respectively;the drug resistance rates of Staphylococcus epidermidis strains to erythromycin,penicillin,and vancomycin were 83.3%,66.7%,and 66.7%,respectively;the drug resistance rates of Staphylococcus aureus strains to erythromycin,penicillin,and vancomycin were 80.0%,80.0%,and 60.0%,respectively;the drug resistance rates of coagulase-negative Staphylococcus strains to erythromycin,penicillin,and vancomycin were 80.0%,60.0%,and 100.0%,respectively.The univariate analysis indicated that the incidence of secondary infection in the herpes zoster patients was associated with the no les than 50 years of age,skin lesion area no less than 500cm2,less standard treatment,and history of contact with varicella zoster virus（P〈0.05）.The result of the multivariate logistic regression analysis showed that the no less than 50 years of age,skin lesion area no less than 500cm2,and less standard treatment were the independent risk factors for the secondary infection in the patients with herpes zoster.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the secondary infection in the patients with herpes zoster.The no less than 50 years of age,skin lesion area no less than 500cm2,and less standard treatment are the risk factors for the secondary infection in the herpes zoster patients.It is the key to take targeted measures according to the etiological characteristics and risk factors so as to reduce the incidence of secondary infection in the herpes zoster patients.