心力衰竭合并2型糖尿病患者肺部感染病原学及其影响因素

Etiological characteristics and influencing factors of pulmonary infection in patients with heart failure and type 2 diabetes mellitus

目的 探讨心力衰竭合并2型糖尿病患者肺部感染病原学特点及其影响因素。方法 回顾性选取124例2020年1月-2022年12月四川省人民医院收治的心力衰竭合并2型糖尿病患者作为研究对象,根据患者是否并发肺部感染分为并发肺部感染组(n=42例)和未并发肺部感染组(n=82例)。收集心力衰竭合并2型糖尿病患者的临床资料,统计并发肺部感染现况及病原学特点,采用多因素Logistic回归分析法分析心力衰竭合并2型糖尿病患者肺部感染的危险因素。结果 124例心力衰竭合并2型糖尿病患者中并发肺部感染为42例,发生率为33.87%;共培养病原菌42株,其中革兰阴性菌23株,占54.76%,主要为铜绿假单胞菌、肺炎克雷伯菌;革兰阳性菌16株,占38.10%,主要为肺炎链球菌;真菌3株,占7.14%,全部为白假丝酵母;有侵入性操作、有慢性阻塞性肺疾病、未预防性使用抗菌药物及C-反应蛋白(CRP)水平高是心力衰竭合并2型糖尿病患者肺部感染的独立危险因素(P<0.05)。结论 心力衰竭合并2型糖尿病患者肺部感染率较高,病原菌主要包括革兰阴性菌中的铜绿假单胞菌、肺炎克雷伯菌,临床可根据心力衰竭合并2型糖尿病患者肺部感染的危险因素给予患者针对性治疗及干预措施。

OBJECTIVE To investigate the etiological characteristics and influencing factors of pulmonary infection in patients with heart failure and type 2 diabetes mellitus. METHODS A total of 124 patients with heart failure combined with type 2 diabetes admitted to the Sichuan People′s Hospital from Jan 2020 to Dec 2022 were retrospectively recruited as the research subjects. According to whether the patients had pulmonary infection, they were divided into the pulmonary infection group(42 cases) and without pulmonary infection group(82 cases). Clinical data of patients with heart failure complicated with type 2 diabetes mellitus were collected, the status and etiological characteristics of pulmonary infection were analyzed. Multivariate logistic regression analysis was used to analyze the risk factors for pulmonary infection in patients with heart failure complicated with type 2 diabetes mellitus. RESULTS Among 124 patients with heart failure combined with type 2 diabetes mellitus, 42 cases were complicated with pulmonary infection(33.87%). Forty-two strains of pathogens were co-cultured, among which 23 strains were gram-negative, accounting for 54.76%, mainly Pseudomonas aeruginosa and Klebsiella pneumoniae, 16 strains of gram-positive bacteria, accounting for 38.10%, mainly Streptococcus pneumoniae. There were three strains of fungi, accounting for 7.14%, all of them were Candida albicans. Invasive procedures, chronic obstructive pulmonary disease, non-prophylactic antibiotic use and high C-reactionprotein(CRP) levels were independent risk factors for pulmonary infection in patients with heart failure and type 2 diabetes(P<0.05). CONCLUSION Patients with heart failure combined with type 2 diabetes mellitus had higher pulmonary infection rate, the gram-negative bacteria P. aeruginosa and K. pneumoniae are the major species of pathogens. According to the risk factors of pulmonary infection in patients with heart failure and type 2 diabetes, targeted treatment and intervention measures can be given clinically.