老年慢性心衰住院患者医院获得性肺炎的病原菌及其影响因素

Distribution of pathogens causing hospital-acquired pneumonia in elderly hospitalized patients with chronic heart failure and influencing factors

目的回顾性分析老年慢性心力衰竭住院患者医院获得性肺炎(hospital-acquired pneumonia,HAP)的病原菌分布及影响因素,为制定有效的医院感染预防和控制方案提供研究依据。方法选取2016年5月-2018年5月华中科技大学同济医学院附属武汉中心医院的825例老年慢性心力衰竭住院患者作为研究对象,对其HAP的发生情况、病原菌分布及影响因素进行回顾性分析。结果 204例患者发生HAP,发生率为24.73%(204/825),122例患者的痰样本中检出病原菌,检出率为59.80%。共检出病原菌145株,其中革兰阴性菌92株、革兰阳性菌40株、真菌13株。金黄色葡萄球菌对青霉素G、氨苄西林、红霉素、磺胺甲噁唑/甲氧苄啶的耐药率较高,对头孢哌酮/舒巴坦、头孢他啶、妥布霉素的耐药率较低,未检出对万古霉素或利奈唑胺耐药的菌株。主要革兰阴性菌对氨苄西林、磺胺甲噁唑/甲氧苄啶、哌拉西林的耐药率较高,对亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星的耐药率较低。Logistic多元回归分析结果显示,老年慢性心衰患者HAP的发生与年龄、心功能分级、合并糖尿病、合并COPD、有侵入性操作、强化饮食护理具有相关性(P<0.05)。结论老年慢性心衰住院患者HAP的发生与年龄、合并症、心功能、治疗护理因素具有相关性,肺炎克雷伯菌等革兰阴性菌是导致感染的主要病原菌,临床医师应给予有效的预防干预并根据药敏试验结果选用敏感性药物进行抗感染治疗。

OBJECTIVE To retrospectively analyze the distribution of pathogens causing hospital-acquired pneumonia(HAP) in the elderly hospitalized patients with chronic heart failure and observe the influencing factors so as to put forward effective measures for prevention and control of nosocomial infection. METHODS A total of 825 elderly patients with chronic heart failure who were hospitalized the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from May 2016 to May 2018 were recruited as the study objects.The incidence of HAP, distribution of pathogens and influencing factors were retrospectively analyzed. RESULTS Totally 204 patients had HAP, with the incidence rate 24.73%(204/825).The pathogens were isolated from sputum specimens of 122 patients, with the isolation rate 59.80%.A total of 145 strains of pathogens were isolated, 92 of which were gram-negative bacteria, 40 were gram-positive bacteria, and 13 were fungi.Staphylococcus aureus strains were highly resistant to penicillin G, ampicillin, erythromycin and sulfamethoxazole-trimethoprim, while the drug resistance rates of the strains to cefoperazone-sulbactam, ceftazidime and tobramycin were low;the strains that were resistant to vancomycin or linezolid were not found.The major species of gram-negative bacteria were highly resistant to ampicillin, sulfamethoxazole-trimethoprim and piperacillin, while the drug resistance rates of the strains to imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam and amikacin were low.The result of multivariate logistic regression analysis showed that the incidence of HAP in the elderly patient with chronic heart failure was associated with the age, cardiac function, complication with diabetes mellitus, complication with COPD, invasive operation and intensive diet nursing(P<0.05). CONCLUSION The incidence of HAP in the elderly hospitalized patient with chronic heart failure is associated with the age, complications, cardiac function and treatment as well as nursing.The gram-negative bacteria such as Klebsiella pneumoniae are dominant among the pathogens causing the infection.It is necessary for clinicians to take effective preventive interventions and use antibiotics based on the result of drug susceptibility testing.