老年呼吸机相关性肺炎患者多重耐药菌感染的危险因素分析

Analysis of risk factors for multidrug-resistant bacteria infection in elderly patients with ventilator-associated pneumonia

目的:分析老年呼吸机相关性肺炎(VAP)患者多重耐药菌(MDRO)感染的危险因素。方法:回顾性分析2019年5月至2022年10月开封市中心医院收治的203例老年VAP患者的临床资料,统计203例老年VAP患者MDRO感染发生率,并根据药敏试验结果将患者分为MDRO组(n=114)和非MDRO组(n=89)。比较两组临床资料,并采用多因素Logistic回归分析VAP患者发生MDRO感染的危险因素。结果:203例老年VAP患者发生MDRO感染114例(56.16%),未发生MDRO感染89例(43.84%);MDRO组患者深静脉置管、留置尿管、意识障碍占比,VAP类型、机械通气时间、抗菌药物种类、抗菌药物使用时间、抗菌药物策略及血清白蛋白水平与非MDRO组比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,机械通气时间≥7 d、晚发型VAP、伴有意识障碍及抗菌药物≥3种、使用时间≥7 d、使用升阶梯疗法均是老年VAP患者感染MDRO的危险因素(OR>1,P<0.05);血清白蛋白水平≥25 g/L是老年VAP患者感染MDRO的保护因素(OR<1,P<0.05)。结论:老年VAP患者MDRO感染风险较高,机械通气时间≥7 d、晚发型VAP、伴有意识障碍及抗菌药物≥3种、使用时间≥7 d、升阶梯疗法均是老年VAP患者感染MDRO的危险因素,血清白蛋白水平≥25 g/L是老年VAP患者感染MDRO的保护因素,临床可据此制订针对性防治措施,以有效改善患者预后。

Objective:To analyze risk factors of multidrug-resistant organism(MDRO)infection in elderly patients with ventilatorassociated pneumonia(VAP).Methods:The clinical data of 203 elderly patients with VAP admitted to the Kaifeng Central Hospital from May 2019 to October 2022 were retrospectively analyzed.The incidence of MDRO infection in the 203 elderly patients with VAP was statistically analyzed.The patients were divided into MDRO group(n=114)and non-MDRO group(n=89)according to the results of drug sensitivity test.The clinical data of the two groups were compared.Logistic multivariate regression was used to analyze the risk factors of MDRO infection in the VAP patients.Results:There were 114 cases(56.16%)of MDRO infection and 89 cases(43.84%)of non-MDRO infection in the 203 elderly patients with VAP.There were statistical differences in the proportion of deep vein catheterization,indwelling urinary catheter,disorders of consciousness,VAP type,mechanical ventilation time,types of antibiotics,use time of antibiotics,strategies of antibiotics,and serum albumin level between the MDRO group and the non-MDRO group(P<0.05).Logistic regression analysis showed that mechanical ventilation time≥7 d,late-onset VAP,combined disturbance of consciousness and≥3 kinds of antibiotics,use time≥7 d,and use of step-up therapy were all risk factors for MDRO infection in the elderly VAP patients(OR>1,P<0.05);the serum albumin level≥25 g/L was a protective factor(OR<1,P<0.05).Conclusions:The elderly patients with VAP have a higher risk of MDRO infection.The mechanical ventilation time≥7 d,late-onset VAP,combined disturbance of consciousness and≥3 kinds of antibiotics,use time≥7 d,and use of step-up therapy are the risk factors for MDRO infection in the elderly VAP patients,while the serum albumin level≥25 g/L is the protective factor.Clinically,targeted prevention and treatment measures can be formulated in order to effectively improve the prognosis of these patients.