老年患者隐匿性肺部感染病原学及危险因素

Related factors and etiological characteristics of occult pulmonary infection in elderly patients

目的 探索老年患者隐匿性肺部感染的危险因素与病原学特点.方法 选取2015年6月-2018年9月于瑞安市人民医院接受治疗的126例高龄社区获得性肺部感染患者为研究对象,按照是否具有隐匿性将患者分为两组,63例具有隐匿性的患者为研究组,63例不具有隐匿性的患者为对照组.观察两组患者的病原菌分布状况,对可能影响老年患者发生隐匿性肺部感染的因素进行分析.结果 126例肺部感染患者检出病原菌中革兰阴性菌89株占70.63%,其中鲍氏不动杆菌占比最高,革兰阳性菌29株占23.02%,其中金黄色葡萄球菌占比最高;单因素分析结果显示,年龄、老年痴呆、甲状腺功能减退、长期卧床、白细胞计数水平与患者发生隐匿性肺部感染有较密切的关系(P<0.05);多因素Logistic回归模型结果显示,年龄、甲状腺功能减退、老年痴呆是老年患者发生隐匿性肺部感染的独立危险因素(P<0.05).结论 高龄隐匿性肺炎患者病原分布以革兰阴性菌为主,其中年龄较大、甲状腺功能减退以及老年痴呆是影响老年患者发生隐匿性肺炎的独立危险因素.

OBJECTIVE To explore the related factors and etiological characteristics of occult pulmonary infection in the elderly patients.METHODS A total of elderly patients with community-acquired pulmonary infection who were treated in Ruian People′s Hospital from Jun 2015 to Sep 2018 were recruited as the study objects,63 patients who had occult infection were assigned as the study group,and 63 patients who did not have occult infection were set as the control group.The distribution of pathogens isolated from the two groups of patients was observed,and the influencing factors for the occult pulmonary infection in the elderly patients were analyzed.RESULTS Among the pathogens isolated from the 126 patients with pulmonary infection,the gram-negative bacteria accounted for 70.63%(89 strains),and the gram-positive bacteria accounted for 23.02%(29 strains);Acinetobacter baumannii was the predominant species of the gram-negative bacteria;Staphylococcus aureus was dominant among the gram-positive bacteria.Univariate analysis showed that the occult pulmonary infection in the elderly patients was closely associated with the age,senile dementia,hypothyroidism,long bedridden time and white blood cell count(P<0.05).Multivariate logistic regression analysis indicated that the age,hypothyroidism and senile dementia were the independent influencing factors for the occult pulmonary infection in the elderly patients(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the elderly patient with occult pneumonia.The old age,hypothyroidism and senile dementia are the independent influencing factors for the occult pneumonia in the elderly patients.