慢性阻塞性肺疾病肺部感染患者病原学分布特征及影响因素

Etiological distribution and influencing factors of COPD patients with pulmonary infection

目的讨论分析慢性阻塞性肺疾病肺部感染患者感染的病原学分布特征,并初步探索慢性阻塞性肺疾病患者出现感染的潜在影响因素。方法研究从2018年1月至2021年1月期间本院就诊的全部慢性阻塞性肺疾病患者295例中选取并发肺部感染患者134例,以及未并发任何感染患者131例纳入此次研究,合计265例患者(并发肺部意外其他器官系统感染者30例,不符合研究纳入排除标准,予以排除)。研究收集受试对象基本情况信息以及潜在影响出现肺感染的因素信息。使用SPSS统计软件包分析研究数据。研究首先对慢性阻塞性肺疾病合并肺感染(134例)患者的病原学进行进一步分析,探讨病原学分布特征。同时研究对比分析慢性阻塞性肺疾病肺感染(134例)和未并发任何感染患者(131例)相关情况,探索影响慢性阻塞性肺疾病患者并发肺感染的相关因素。结果患者研究检出菌株共149株,肺部感染的病原菌以革兰阴性菌所占比例更高(97/149,65.10%),革兰阳性菌50株(50/149,33.56%),其他(真菌等)2株(2/149,1.34%)。革兰阴性菌中菌种包含:鲍曼不动杆菌(53/149,35.57%)、肺炎克雷伯菌(25/149,16.78%)、铜绿假单胞菌(16/149,10.74%)、大肠埃希菌(3/149,2.01%);革兰阳性菌中包含菌种:金黄色葡萄球菌(24/149,16.11%),表面葡萄球菌(13/149,8.72%)、溶血葡萄球菌(9/149,6.04%)、肺部感染链球菌(4/149,2.68%)。对比慢性阻塞性肺疾病肺感染(134例)和未并发任何感染患者(131例)相关情况,提示感染患者中年龄>60岁、吸烟史、并见2型糖尿病、使用机械通气、抗菌药物使用时间>15 d的比例更高(均有P<0.05)。进一步进行单因素和多因素logistics回归模型进行增加肺感染风险的影响因素分析,最终多因素模型分析可见年龄>60岁、吸烟史、并见2型糖尿病、抗菌药物使用时间>15d OR值均表现为危险因素,且均有P<0.05。结论慢性阻塞性肺疾病患者发生肺感染病原菌以革兰阴性菌为主,年龄高、吸烟史、并见2型糖尿病以及抗菌药物使用时间长的患者发生肺感染风险更大,值得临床关注。

Objective To discuss the Etiological Distribution of COPD patients and explore the potential influencing factors of COPD infection.Methods From January 2018 to January 2021,134 patients with concurrent pulmonary infection and 131 patients without any infection were selected from all 295 patients with COPD treated in our hospital.A total of 265 patients(30 patients with accidental pulmonary infection and other organ system infection,which did not meet the inclusion and exclusion criteria of this study,were excluded).The study collected the basic information of subjects and the information of potential factors affecting pulmonary infection.SPSS statistical software package was used to analyze the research data.Firstly,the etiology of patients with COPD infection(134 cases)was further analyzed to explore the distribution characteristics of etiology.At the same time,the related conditions of COPD patients with infection(134 cases)and patients without any infection(131 cases)were compared and analyzed to explore the related factors affecting COPD patients with pulmonary infection.Results A total of 149 bacterial strains were detected in this study.Gram-negative bacteria accounted for a higher proportion of lung infection(97/149,65.10%),gram-positive bacteria 50 strains(50/149,33.56%),and other(fungi,etc.)2 strains(2/149,1.34%).Gram-negative bacteria included acinetobacter baumannii(53/149,35.57%),klebsiella pneumoniae(25/149,16.78%),pseudomonas aeruginosa(16/149,10.74%)and escherichia coli(3/149,2.01%).gram-positive bacteria included staphylococcus aureus(24/149,16.11%),staphylococcus superficial(13/149,8.72%),staphylococcus haemolyticus(9/149,6.04%),and streptococcus pneumoniae(4/149,2.68%).Compared with chronic obstructive pulmonary disease(134 cases)and without any infection(131 cases),it was suggested that the proportion of patients aged>60 years,smoking history,type 2 diabetes mellitus,mechanical ventilation and antibiotics use time was>15 days(P<0.05).Further univariate and multivariate Logistics regression models were used to analyze the risk factors of increased pulmonary infection.Finally,multivariate analysis showed that age>60 years,smoking history,type 2 diabetes mellitus,and>15 OR duration of antimicrobial use were all risk factors,and all of them had P<0.05.Conclusion Gram negative bacteria are the main pathogens of lung infection in COPD patients.The risk of lung infection is higher in patients with high age,smoking history,type 2 diabetes and long time use of antibiotics,which is worthy of clinical attention.