医院获得性肺炎患者多重耐药菌易感因素分析

Risk Factors of Multiple Drug-Resistant Bacteria in Patients with Hospital-Acquired Pneumonia

目的:探讨医院获得性肺炎(HAP)患者感染多重耐药菌(MDRO)的危险因素,为临床感染防治提供参考。方法:选取2019年4月-2021年3月福建医科大学附属第二医院所有确诊为HAP的患者共395例作为研究对象,根据HAP患者的痰、支气管肺泡灌洗液等相关标本的培养结果,将感染MDRO的患者列为病例组(n=231),感染非MDRO(包括无细菌感染)的患者列为对照组(n=164),统计两组性别等研究因素并进行单因素分析,再对上述差异有统计学意义的指标进一步进行多因素Logistic回归方程分析。结果:395例HAP患者生物标本共检出病原菌387株,其中MDRO共231株,占总菌株的59.69%。病原菌分布以革兰阴性菌为主,主要为鲍曼不动杆菌占比23.58%,其次分别为铜绿假单胞菌占18.91%,肺炎克雷伯菌占16.32%等;主要的革兰阳性菌包括金黄色葡萄球菌占10.36%,肺炎链球菌占9.33%,粪肠球菌占8.03%。病例组与对照组年龄、是否合并肺部基础疾病、是否有抗生素使用史、是否有动静脉置管、气管切开、留置胃管等侵入性操作史等因素比较,差异有统计学意义(P<0.05);经过Logistic回归分析HAP患者感染MDRO的危险因素包括合并肺部基础疾病、有抗生素使用史、有动静脉置管、气管切开、留置胃管等侵入性操作史。结论:合并肺部基础疾病、有抗生素使用史、有动静脉置管、气管切开、留置胃管等侵入性操作史是HAP患者感染MDRO的独立危险因素。

Objective:To investigate the risk factors of multiple drug-resistant bacteria(MDRO)infection in patients with hospital-acquired pneumonia(HAP),to provide reference for prevention and treatment of clinical infection.Method:A total of 395 HAP patients were selected from the Second Affiliated Hospital of Fujian Medical University from April 2019 to March 2021,patients infected with MDRO were classified as the case group(n=231)and those infected with non-MDRO(including no bacterial infection)were classified as the control group(n=164)according to the culture results of sputum and Bronchoalveolar lavage fluid of HAP patients,the sex and other factors of the patients in the two groups were analyzed by single factor analysis,and then the Logistic regression equation was used to analyze the above-mentioned indexes.Result:A total of 387 strains of pathogenic bacteria were detected in 395 HAP patients,of which 231 strains were MDRO,accounting for 59.69%of the total strains.The main pathogens was Gram-negative bacterium,they were acinetobacter Bowman(23.58%),pseudomonas Aeruginosa(18.91%)and Klebsiella pneumoniae(16.32%).The major Gram-positive bacteria were Staphylococcus aureus 10.36%,Streptococcus pneumoniae 9.33%and Enterococcus faecalis 8.03%.There were significant differences between case group and control group in age,pulmonary disease,history of antibiotic use,history of arteriovenous catheterization,tracheotomy and gastric tube indwelling(P<0.05).Logistic regression analysis showed that the risk factors of HAP patients with MDRO included pulmonary underlying diseases,history of antibiotic use,history of arteriovenous catheterization,tracheotomy and indwelling gastric tube.Conclusion:The risk factors of MDRO infection in HAP patients are associated with pulmonary underlying diseases,history of antibiotic use,arteriovenous catheterization,tracheotomy and indwelling gastric tube.