老年人下呼吸道痰液检出纹带棒状杆菌的易感因素和疗效分析

Analysis of susceptibility factors and curative effect of corynebacterium striatum detected in sputum of lower respiratory tract the elderly

目的观察老年下呼吸道痰液纹带棒状杆菌阳性患者的易感因素,分析其临床治疗效果。方法回顾性分析2019年1月至2021年6月福建医科大学附属泉州第一医院192例下呼吸道痰液检出纹带棒状杆菌老年住院患者的临床资料,计算纹带棒状杆菌检出率,并对感染组(102例)与定植组(90例)患者的易感因素及临床疗效进行比较。结果福建医科大学附属泉州第一医院2019年112月送检合格下呼吸道痰标本8976例,72例(0.8%)检出纹带棒状杆菌;2020年1-12月送检合格下呼吸道痰标本5877例,134例(2.3%)检出纹带棒状杆菌;2021年1一6月送检合格下呼吸道痰标本4039例,121例(3.0%)检出纹带棒状杆菌,差异有统计学意义(χ^(2)=93.93,P<0.01);其中老年患者纹带棒状杆菌检出率分别为0.6%(57/8976)、1.4%(81/5877)和1.9%(78/4039),差异有统计学意义(χ^(2)=45.57,P<0.01)。感染组患者高龄、入住重症医学科、营养不良、应用激素、联合应用抗菌药物、有创机械通气、纤维支气管镜、咳嗽反射减弱、基础疾病等方面的发生率均高于定植组,但差异无统计学意义(均P>0.05);感染组和定植组患者治疗临床有效率分别为41.2%(42/102)和48.9%(44/90),差异无统计学意义(P>0.05);感染组25例(24.5%)患者根据药敏结果治疗纹带棒状杆菌,与无药敏结果治疗患者的临床有效率分别为68.0%(17/25)和32.5%(25/77),差异有统计学意义(χ^(2)=9.84,P<0.01);未治疗组的临床有效率低于定植组,差异有统计学意义(χ^(2)=4.62,P<0.05)。结论老年患者纹带棒状杆菌检出率高并呈逐年增加趋势,感染者通常存在多种易感因素,未采取有效治疗措施可导致不良结局。在临床工作中,需关注且减少纹带棒状杆菌易感因素,正确解读病原学报告并采取合理有效的治疗方案。

ObjectiveToobserve the susceptibility factors of elderly patientswith corynebacterium striata in sputum of lower respiratory tract and analyze its clinical therapeutic effect.MethodsThe clinical data of 192 elderly inpatients infected with corynebacterium striatum detected in sputum of lower respiratory tract were retrospectively analyzed in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2019 to June 2021.The detection rate of corynebacterium striata was calculated,and the susceptibility factors and clinical efficacy were compared between the infection group(n=102)and the colonization group(n=90).ResultsThe detection rate of corynebacterium striata(detected cases/numbers of qualified lower respiratory tract sputum specimen)was 0.8%(72/8976)from January to December 2019,2.3%(134/5877)from JanuarytoDecember 2020,and3.0%(121/4039)from January to June2021,thedifferencewas statistically significant(X^(2)=93.93,P<0.01).The detection rates of corynebacterium striatum during three corresponding periods in elderly patients were 0.6%(57/8976),1.4%(81/5877)and 1.9%(78/4039),respectively,with statistically significant dfferences(X^(2)=45.57,P<0.01).The incidences or values of following indexes were higher in infection group than in colonization group:age of patients,admission of intensive care unit,malnutrition,use of hormones,combined use of antibiotics,use of invasive mechanical ventilation,use of fiber bronchoscope,reduced cough reflex,other basic diseases,and so on,but the differences were not statistically significant(all P>0.05).The clinical effective rates were 41.2%(42/102)in the infection group and 48.9%(44/90)in the colonization group,respectively,and the differences was not statistically significant(P>0.05).Only 25 patients(24.5%)in the infected group were treated on corynebacterium striatum according to drug sensitivity results.Among them,the clinical ffective rate of the treatment group and the untreated group was 68.0%(17/25)and 32.5%(25/77),respectively,the difference was statistically significant(X^(2)=9.84,P<0.01).The clinical effective rate of untreated group was lower than that of colonization group,the difference was statistically significant(X^(2)=4.62,P<0.05).ConclusionsThe detection rate of corynebacterium striatum in elderly patients is high,and increases year by year.Patients infected with corynebacterium striatum usually has a variety of susceptibility factors,if not taking effective treatment measures,may have adverse outcomes In clinical work,it is necessary to pay attention to and reduce the susceptibility factors of corynebacterium striatum,and to correctly interpret the etiological reports,so as to adopt a reasonable and effective therapeutic schedule.