老年慢性阻塞性肺疾病患者和坠积性肺炎患者肺内病原菌比较及感染影响因素分析

The pathogenic bacteria in the lungs and its related factors in aged patients with COPD or hypostatic pneumonia

目的对比老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者和坠积性肺炎患者肺内一般病原菌和多重耐药菌的分布,同时分析COPD患者和坠积性肺炎患者多重耐药菌感染的影响因素。方法对入选COPD患者和坠积性肺炎患者下呼吸道痰标本进行培养和鉴定,对比两组患者病原菌以及多重耐药菌的检出率,同时比较两组患者性别、年龄、住院时间、糖尿病病史、有创机械通气治疗和留置尿管等因素对多重耐药菌感染的影响。结果COPD患者革兰阴性菌的检出率(48.39%)显著低于坠积性肺炎患者(66.13%),COPD患者真菌的检出率(11.06%)显著高于坠积性肺炎患者(2.42%)。两组患者检出的多重耐药菌均以产超广谱β-内酰胺酶肠杆菌科细菌、耐甲氧西林金黄色葡萄球菌和多重耐药/泛耐药铜绿假单胞菌为主。COPD患者中感染多重耐药菌患者的年龄和住院时间显著高于非感染患者;坠积性肺炎患者中感染多重耐药菌患者的住院时间、机械通气治疗率和留置尿管使用率显著高于非感染患者。结论影响老年COPD患者和坠积性肺炎患者多重耐药菌感染的因素有区别,应有针对性地应用抗生素以减少多重耐药菌的感染。

Objective To compare the distribution of general pathogens and multidrug-resistant bacteria,and analyze the influencing factors of multi-drug resistant infections in aged patients with chronic obstructive pulmonary disease(COPD).Methods The sputum specimens from the lower respiratory tracts of patients with COPD and patients with hypostatic pneumonia were cultured and identified.The detection rates of pathogens and multi-drug resistant bacteria were compared between the two groups.The effects of gender,age,length of hospital stay,history of diabetes,invasive mechanical ventilation and indwelling catheters were compared between the two groups.Results The detection rate of Gram-negative bacteria in COPD patients(48.39%)was significantly lower than that in patients with hypostatic pneumonia(66.13%),while that of fungi(11.06%)was significantly higher than in patients with hypostatic pneumonia(2.42%).The multi-drug resistant bacteria detected in the two groups were mainly ESBLs,MRSA and MDR/PDR-PA.The age and hospitalization time of COPD patients with multidrug-resistant bacteria infections were significantly higher than those with no infections;the hospitalization time,rate of mechanical ventilation treatment and use of indwelling catheter in hypopigmatic pneumonia patients with multidrug-resistant bacteria infections were significantly higher than in those with no infections.Conclusion The influencing factors of multidrug-resistant bacteria infections were different between the patients with COPD and patients with epidemic pneumonia.Antibiotics should be rationally used to reduce the multidrug-resistant bacteria infection.