河北省某院老年患者肺部感染流行病学特征及风险预测模型的构建

Epidemiological characteristics and risk prediction model of pulmonary infection in elderly patients in a hospital in Hebei Province

目的 分析老年肺部感染的流行病学特征及影响因素,并构建风险预测模型。方法 采用分层整群抽样方式随机抽取张家口市第一医院683例老年患者为调查对象,将其痰标本送细菌分离培养、鉴定,并做药物敏感试验,根据患者是否发生肺部感染分为肺部感染组(n=315)和非肺部感染组(n=368),分析两组患者年龄、性别、是否合并COPD、是否入住ICU等临床资料,采用单因素分析和logistic回归分析老年患者肺部感染的影响因素,建立风险预测模型。结果 315例肺部感染患者共检出331株病原菌,革兰氏阴性菌共207株(62.54%),主要是鲍曼不动杆菌95株(28.70%)、肺炎克雷伯菌71株(21.45%)等;其中革兰氏阳性菌共169株(26.28%),主要是金黄色葡萄球菌68株(20.54%)等;真菌共25株(7.55%);两组患者性别、吸烟史、合并COPD、哮喘、脑卒中病史间差异无统计学意义(P>0.05);试验组患者年龄≥70岁、机械通气、入住ICU及近期有呼吸道感染比例显著高于对照组(P<0.05)。多因素logistic回归分析结果显示年龄、吸烟史、机械通气、入住ICU是老年患者发生肺部感染的独立危险因素(P<0.05)。根据上述4个独立影响因素及各因素对应的回归系数,构建老年患者发生肺部感染的预测模型,Z=-5.948+1.198×(年龄)+1.281×(吸烟史)+2.029×(机械通气)+1.211×(入住ICU)。结论 该院老年肺部感染以革兰阴性杆菌为主,应根据药敏结果合理地选用抗生素,年龄≥70岁、合并COPD等可增加老年患者发生肺部感染的风险,构建的预测模型可有效预测老年患者肺部感染的发生。

Objective To analyze the epidemiological characteristics and influencing factors of pulmonary infection in the elderly, and to construct a risk prediction model. Methods Stratified cluster sampling was used to randomly select 683 elderly patients in Zhangjiakou First Hospital as the investigation subjects.Sputum specimens were collected and sent for bacterial isolation, culture, identification, and drug sensitivity test.According to whether the patients had pulmonary infection, they were divided into pulmonary infection group(n=315) and non-pulmonary infection group(n=368).The clinical data of the two groups such as age, sex, COPD,and ICU admission were analyzed.Univariate analysis and logistic regression analysis were used to analyze the influencing factors of pulmonary infection in elderly patients, and a risk prediction model was established. Results A total of 331 strains of pathogenic bacteria were detected in 315 patients with pulmonary infection, and there were 207 strains(62.54%) of gram-negative bacteria detected, mainly including 95 strains(28.70%) of Acinetobacter baumannii and 71 strains(21.45%) of Klebsiella pneumoniae.There were 169 strains(26.28%) of gram-positive bacteria detected, mainly 68 strains(20.54%) of Staphylococcus aureus.In addition, there were 25 strains of fungi(7.55%).There were no significant differences in gender, smoking history, history of COPD,asthma, and stroke between the two groups(P>0.05).The proportion of patients aged≥70,mechanical ventilation, admission to ICU and recent respiratory tract infection in the experimental group was significantly higher than that in the control group(P<0.05).Multivariate logistic regression analysis showed that age, smoking history, mechanical ventilation, and ICU admission were independent risk factors for pulmonary infection in elderly patients(P<0.05).According to the above four independent influencing factors and corresponding regression coefficient of each factor, the prediction model of pulmonary infection in elderly patients was constructed, Z=-5.948+1.198×(age) +1.281×(smoking history) +2.029×(mechanical ventilation) +1.211×(ICU admission). Conclusion Lung infection in elderly patients in our hospital is dominated by gram-negative bacilli.Antibiotics should be rationally selected according to drug sensitivity results.Age≥70 years old and COPD can increase the risk of pulmonary infection in elderly patients, and the prediction model constructed can effectively predict the occurrence of pulmonary infection in elderly patients.