老年人卫生保健相关性肺炎复数菌感染的相关因素分析

The analysis of related factors for multiple bacterial infection in elderly patients with health care-related pneumonia

目的︰分析老年人卫生保健相关性肺炎(HCAP)复数菌感染的相关因素,为临床提供参考。方法﹐收集贵州医科大学第三附属医院2015年2月至2018年12月收治的老年HCAP患者,符合纳入标准1012例,按照是否分离出复数感染菌分为单一细菌感染HCAP组与复数菌感染HCAP组,比较两组患者病原菌分布情况,并对复数菌感染的相关因素进行分析。结果复数菌感染HCAP组122例,检出病原菌286株,单数菌感染HCAP组890例,检出病原菌890株;两组病原菌分布比较结果显示,与单数菌感染组比较,复数菌感染组在革兰阳性菌中金黄色葡萄球菌与屎肠球菌较高,而表皮葡萄球菌占比相对较低(χ^(2)=11.086,8.460、4.056,P=0.001,0.004,0.044);复数菌感染组在革兰阴性菌中铜绿假单胞菌、嗜麦芽窄食假单胞菌感染比例较单数菌感染组高,而大肠埃希菌与肺炎克雷伯菌占比相对较低(χ^(2)=7.495,4.918、9.011,4.604,P=0.006,0.027,0.003,0.032)。多因素Logistic回归分析结果显示,30 d内联用抗菌药物(≥3种)、慢性基础疾病(≥2种)、肺炎严重指数(PSI)分级(高),90 d内住院天数(≥15 d)、90 d内入住ICU史、年龄(≥70岁)为老年人HCAP复数菌感染的独立危险因素(OR=2.389、1.840、1.289,1.877、2.089、1.981,P=0.001,0.003,0.001,0.002,0.001,0.002)。结论﹑老年人HCAP复数菌感染与多因素有关,应重点关注病情重、基础疾病多与高龄患者,缩短不必要的住院时间,减少人住重症监护病房时间,合理选用抗菌药物,减少不必要的联合使用抗菌药物是减少老年人HCAP复数菌感染的有效措施。

Objective To analyze the related factors for plural bacterial infection in elderly patientswith health care-associated pneumonia(HCAP),in order to provide the reference for clinical practice.Methods A total of the 1012 elderly patients conforming to inclusion criteria were in the age of 60-87(70.7±6.2)years,with 431 cases of males and 581 cases of females.The clinical data of elderly patients withHCAP admitted to our hospital from February 2015 to December 2018 were collected.Acording to thenumber of infected bacteria category,the patients were divided into the single bacterial infection group and theplural bacterial infection group.The distribution of pathogens was compared between the two groups,and therelated factors for plural bacterial infection were analyzed.ResultsThere were 122 HCAP cases in theplural bacterial infection group,with 286 strains of pathogenic bacteria detected,while 890 HCAP cases werefound in the single bacterial infection group,with 890 strains of pathogenic bactera detected.Compared withthe single infection group,the plural bacteria infection group showed that the proportions of Gram-positiveStaphylococcus aureus and Enterococcus faecium were increased,while the proportion of Staphylococcusepidermidis was relatively decline(χ^(2)=11.086,8.460 and 4.056,P=0.001,0.004 and 0.044).The proportions of Gram-negative Pseudomonas aeruginosa and Stenotrophomonas maltophilia were higher,whilethe proportions of Escherichia coli and Klebsiella were lower in the plural bacteria infection group than in thesingle bacteria infection group(χ^(2)=7.495,4.918,9.011 and 4.604,P=0.006,0.027,0.003 and 0.032).Multivariate Logistic regression analysis showed that the independent risk factors for plural bacteria infectionin elderly HCAP patients were the combined use of antibiotics within 30 days(≥3 kinds),more chronicunderlying diseases(≥2 kinds),pneumonia severity index(PSI)classification being high,longer hospitalizationtime within 90 days(≥15 days),a history of ICU stays within 90 days,age(≥70 years old)(OR=2.389,1.840,1.289,1.877,2.089 and 1.981,P=0.001,0.003,0.001,0.002,0.001 and 0.002,respectively).Conclusions The plural bacteria infection in elderly HCAP patients is related to many factors.The effectivemeasure to reduce the plural bacteria infection in elderly HCAP patients are to focus on patients with severedisease,more basic diseases and advanced age,and on the shortening of the unnecessary hospitalization time,the reducing of the time of ICU stays,the reasonably selecting of antibiotics,the reducing of the unnecessarycombination of antibacterial drugs.