慢性阻塞性肺疾病急性发作患者复种菌感染相关因素分析

Relevant factors of multiple bacterial infections in patients with acute exacerbation of chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病急性发作(AECOPD)患者复种菌感染的相关因素。方法回顾性收集2014年6月至2018年12月贵州医科大学第三附属医院呼吸内科收治的AECOPD患者1622例,采集患者深部痰标本分离培养,并分为非复种菌感染组与复种菌感染组,对其进行复种菌感染相关因素分析。采用SPSS20.0统计软件对数据进行处理。组间比较采用χ^2检验。采用多因素logistic回归法分析影响AECOPD患者复种菌感染的独立危险因素。结果非复种菌感染组与复种菌感染组患者分别占89.89%(1458/1622)与10.11%(164/1622)。与非复种菌感染组比较,复种菌感染组患者年龄≥70岁、吸烟史≥10年、发病年限≥5年、并发症、糖皮质激素使用频率≥5次/年、3个月内糖皮质激素使用时间≥7d、3个月内使用抗菌药物种数≥3种、3个月内联用抗菌药物≥3种、血糖≥11.1mmol/L比例显著升高,差异有统计学意义(P<0.05)。多因素logistic回归模型分析显示,3个月内联用抗菌药物≥3种(OR=1.874,95%CI1.276~2.751;P=0.001)、吸烟史≥10年(OR=1.525,95%CI1.037~2.241;P=0.032)、并发症(OR=1.899,95%CI1.276~2.827;P=0.002)、3个月内糖皮质激素使用时间≥7d(OR=2.053,95%CI1.375~3.064;P<0.001)、年龄≥70岁(OR=2.098,95%CI1.445~3.045;P<0.001)等为AECOPD复种菌感染的独立危险因素。结论高龄、基础疾病多、长期吸烟、盲目大范围联合使用抗菌药物及长时间使用糖皮质激素可能是AECOPD复种菌感染的主要原因。

Objective To analyze the related factors of multiple bacterial infections in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 1 622 AECOPD patients admitted in our Department of Respiratory Medicine from June 2014 to December 2018 were enrolled and retrospectively analyzed. According to the results of culture of deep sputum specimens,they were divided into non- multiple bacterial infection group and multiple bacterial infection group. The related factors of multiple bacterial infections were analyzed. SPSS statistics 20.0 was used to process the data. Chi-square test was employed for comparison between groups. Multivariate logistic regression was applied to analyze the independent risk factors for multiple bacterial infections in these AECOPD patients. Results The non-multiple bacterial infection group accounted for 89.89%(1 458/1 622),while the multiple bacterial infection group for 10.11%(1 64/1 622) of the patients. Compared with the non-multiple bacterial infection group,the another group had larger percentage of those over 70 years old,history of smoking ≥10 years,disease course longer than 5 years,complications,frequency of glucocorticoid use ≥5 times/year, glucocorticoid use time within 3 months ≥7 d,number of antibacterial drugs used within 3 months ≥3,number of combined antibiotics within 3 months ≥3,and blood glucose ≥11.1 mmol/L (all P <0.05). Multivariate logistic regression model analysis showed that the combination of antibiotics within 3 months ≥3 ( OR =1.874 ,95% CI 1.276-2.751;P =0.001),smoking history ≥10 years( OR =1.525 ,95% CI 1.037-2.241;P =0.032),complications( OR =1.899,95% CI 1.276-2.827;P =0.002),glucocorticoid use time within 3 months ≥7 d ( OR =2.053,95% CI 1.375-3.064;P <0.001) and age ≥70 years ( OR =2.098,95% CI 1.445-3.045;P <0.001) were independent risk factors for multiple bacterial infections in AECOPD. Conclusion Older age, multiple basic diseases,long-term smoking,blind use of antibiotics and long-term use of glucocorticoids may be the main causes of multiple bacterial infections in AECOPD patients.