老年患者肺部铜绿假单胞菌感染临床特征及多重耐药株感染危险因素分析

Clinical Characteristics of Pulmonary Pa Infection and Risk Factors of MDR-Pa Infection in the Elderly

目的总结老年患者肺部铜绿假单胞菌(Pa)感染的临床特点及多重耐药株感染的危险因素。方法研究纳入老年肺部Pa感染患者203例,分为院内感染组(106例)与院外感染组(97例),检测所获得细菌样本的药敏,比较各组Pa感染的临床特点,得出多重耐药Pa感染的高危因素。结果院内感染组有创通气率、住院天数、死亡率、卒中发生率、鼻饲率高于院外感染组,院外感染组既往住院史、合并结构性肺病比例等高于院内感染组(P<0.05)。院内感染组多重耐药Pa检出率高于院外感染组,在院内感染组中氨基糖苷类、碳青霉烯类耐药率高于院外感染组(P<0.05)。90d内住院史(OR 3.56;95%CI 0.96～13.14)是院外感染组MDR-Pa的高危暴露因素(P<0.05)。碳青霉烯类(OR 2.44;95%CI1.03～5.79)、喹诺酮类(OR 2.87;95%CI 1.14～7.26)应用史是院内感染组中MDR-Pa检出的危险因素(P<0.05)。结论院内及院外肺部Pa感染临床特点不同,应根据各自特点加以预防及治疗。抗感染治疗时应避免碳青霉烯等广谱抗菌药物长期应用。

Objective To discuss the clinical characteristics of pulmonary pseudomonas aeruginosa(Pa)infection and the risk factors of multi-drug resistant pseudomonas aeruginosa infection(MDR-Pa).Methods 203 elderly with pulmonary Pa infection were enrolled in the 2 groups:in-hospital infection group(n=106)and out-hospital infection group(n=97);the drug sensitiveness of bacteria samples was detected and clinical charateristics of Pa infection in the 2 groups were compared.Results The rates of invasive ventilation,hospitalization days,mortality,stroke occurrence and nasal feeding in in-hospital infection group were higher than those in out-hospital infection group(P<0.05)while the proportions of previous hospitalization history and combination of structural lung diseases in out-hospital infection group were bigger than those in in-hospital infection group(P<0.05);the detection rate of MDR-Pa,the resistance rates of aminoglycoside and carbapenem in in-hospital infection group were higher than those in out-hospital infection group(P<0.05);hospitalization with 90 days(OR:3.56,95%CI:0.96,13.14)was the high risk factor for MDR-Pa in out-hospital infection group(P<0.05)and the application of carbapenems(OR:2.44,95%CI:1.03,5.79)and quinolones(OR:2.87,95%CI:1.14,7.26)were the risk factors of MDR-Pa detection in in-hospital infection group(P<0.05).Conclusions The clinical characteristics of in-hospital and out-hospital pulmonary Pa infection are different and related prevention and treatment should be provided;long-term application of broad-spectrum antibiotics such as carbapenems should be avoided in anti-infection treatment.