带状疱疹患者感染的病原菌分布及相关因素研究

Distribution of pathogens causing infections in patients with herpes zoster and related factors

目的研究带状疱疹患者感染的病原菌分布及相关因素,为感染的预防和治疗工作提供客观依据。方法选取2016年2月-2017年3月2068例带状疱疹患者作为研究对象。分析患者感染率及与感染相关的影响因素,并检测患者感染病原菌分布及耐药性。结果 2068例患者中感染192例,感染率为9.28%,共分离病原菌198株,其中,革兰阴性菌151株占76.26%,革兰阳性菌41株占20.71%,真菌6株占3.03%,肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主要病原菌。革兰阴性菌对庆大霉素、环丙沙星的耐药率较高,对美罗培南、阿米卡星的耐药率较低。革兰阳性菌对青霉素G、红霉素的耐药率较高,对万古霉素、利福平的耐药率较低。单相关因素分析结果显示,年龄≥60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的带状疱疹患者的感染率较高,差异有统计学意义(P<0.05)。Logistic多元回归分析结果显示,带状疱疹患者感染的发生与年龄、皮损面积、接受治疗情况和水痘-带状疱疹病毒接触史具有相关性(P<0.05)。结论带状疱疹患者感染的病原菌分布和相关影响因素均具有一定的特征性,临床医生应给予高度的重视和合理的干预,从而达到降低感染率、促进疾病康复的目的。

OBJECTIVE To investigate the distributions of pathogens causing infection in patients with herpes zoster and analyze the related factors so as to provide objective basis for prevention and treatment of the infections.METHODS A total of2068 patients with herpes zoster who were treated from Feb 2016 to Mar 2017 were recruited as the study objects.The infection rates and influencing factors for the infections were observed,and the distribution and drug resistance of pathogens causing the infections were analyzed.RESULTS Of the 2068 patients,192 had infections,with the infection rate 9.28%.Totally 198 strains of pathogens were isolated,151（76.26%）of which were gram-negative bacteria,41（20.71%）were gram-positive bacteria,and 6（3.03%）were fungi.Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli were the predominant species of pathogens.The gram-negative bacteria were highly resistant to gentamicin and ciprofloxacin,while the drug resistance rates to meropenem and amikacin were low.The gram-positive bacteria were highly resistant to penicillin G and erythromycin,while the drug resistance rates to vancomycin and rifampicin were low.The result of univariate analysis indicated that the infection rate was high in the herpes zoster patients with no less than 60 years of age,area of skin lesion no less than 500 cm2,absence of standard therapy or exposure to varicella zoster virus,and there was significant difference（P〈0.05）.The result of multivariate logistic regression analysis showed that the incidence of infection in the herpes zoster patients was associated with age,area of skin lesion,status of therapy and exposure to varicella zoster（P 〈0.05）.CONCLUSION The distribution of pathogens and related influencing factors show certain characteristics among the patients with herpes zoster.The clinicians should pay high attention to them and take appropriate intervention measures so as to reduce the infection rate and facilitate the recovery of the patients.