锦州地区老年吸入性肺炎病原菌特点及相关因素分析

Analysis of Pathogenic Bacteria Characteristics and Related Factors of Aspiration Pneumonia in Elderly Patients in Jinzhou Area

目的分析锦州地区老年吸入性肺炎病原菌的特点、耐药性及相关危险因素,为临床指导抗生素的使用及预防吸入性肺炎的发生提供依据。方法收集我院呼吸内科2017年1月至2020年12月诊治的老年肺炎患者246例,其中吸入性肺炎115例,非吸入性肺炎131例,分析吸入性肺炎感染病原菌特点、耐药性及相关危险因素在两组间的差异。结果(1)115例吸入性肺炎患者中,有35例患者痰液中检出病原菌(30.4%),共38株,其中革兰氏阴性菌35株(92.1%)、革兰氏阳性菌3株(7.9%),分别对检出病原菌进行耐药情况分析;(2)单因素分析结果显示两组间在意识障碍(χ^(2)=-3.071,P<0.05)、吞咽困难(χ^(2)=-3.328,P<0.05)、咳嗽反射(χ^(2)=-2.617,P<0.05)、长期卧床(χ^(2)=-2.389,P<0.05)、低白蛋白血症(χ^(2)=-3.896,P<0.05)、留置胃管(χ^(2)=-4.028,P<0.05)等因素存在显著差异;(3)多元Logistic回归分析结果显示长期卧床、低白蛋白血症、留置胃管均是吸入性肺炎的危险因素(P<0.05)。结论老年吸入性肺炎感染病原菌复杂,易诱发耐药菌产生,且与多种因素相关,需要制定个体化预防及治疗措施。

Objective To analyze pathogenic bacteria characteristics,drug resistance and related risk factors of aspiration pneumonia in elderly patients in Jinzhou,so as to provide basis for clinical guidance on the use of antibiotics and the prevention of aspiration pneumonia.Methods 246 elderly patients with pneumonia admitted in respiratory department of our hospital from January 2017 to December 2020 were collected,including 115 cases of aspiration pneumonia and 131 cases of non-aspiration pneumonia.The characteristics of pathogens,drug resistance and related risk factors in the two groups were analyzed.Results(1)Among the 115 patients with aspiration pneumonia,pathogenic bacteria were detected in 35 cases(30.4%),and 38 strains were detected,including 35 strains of Gram-negative bacteria(92.1%)and 3 strains of Gram-positive bacteria(7.9%).The drug resistance of pathogens was analyzed respectively.(2)Univariate analysis showed that there were significant differences between the two groups in consciousness disorder(χ^(2)=-3.071,P<0.05),dysphagia(χ^(2)=-3.328,P<0.05),cough reflex(χ^(2)=-2.617,P<0.05),being long-term bedridden(χ^(2)=-2.389,P<0.05),hypoalbuminemia(χ^(2)=-3.896,P<0.05),indwelling gastric tube(χ^(2)=-4.028,P<0.05)and other factors;(3)Multiple logistic regression analysis showed that being long-term bedridden,hypoalbuminemia and indwelling gastric tube were all risk factors for aspiration pneumonia(P<0.05).Conclusion As the pathogen of aspiration pneumonia infection in the elderly is complex,it is easy to induce the emergence of drug-resistant bacteria,which is related to many factors,so it is necessary to formulate individual prevention and treatment measures.