老年2型糖尿病合并社区获得性肺炎的病原学特点及死亡危险因素分析

Etiological Characteristics and Risk Factors of Death in Elderly Patients with Type 2 Diabetes Mellitus Complicated with Community-acquired Pneumonia

目的探究老年2型糖尿病合并社区获得性肺炎(CAP)病原学特点及影响死亡的危险因素。方法回顾性分析2021年4月至2023年4月收治的190例老年2型糖尿病合并CAP的病例资料,依据院内预后情况分为死亡组和存活组。比较2组感染的病原菌分布特点及临床资料,采用多因素Logistic回归分析老年2型糖尿病合并CAP患者死亡的相关危险因素。结果190例老年2型糖尿病合并CAP院内存活159例,占83.68%;死亡31例,占16.32%。检出病原菌包括革兰阴性菌164株、革兰阳性菌94株,真菌9株,分别占61.42%、35.21%、3.37%。检出鲍曼不动杆菌53株、肺炎克雷伯菌46株、金黄色葡萄球菌46株,肺炎链球菌32株、铜绿假单胞菌24株,分别占总病原菌的19.85%、17.23%、17.23%、11.99%、8.99%。死亡组鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌及混合菌感染率高于存活组(P<0.05)。机械通气、慢性肾脏病、肺炎严重度指数(PSI)评分≥130分、脓毒症、糖化血红蛋白(HbA1c)>8.0%、白细胞计数(WBC)>10×10^(9)/L,血乳酸、血肌酐、C反应蛋白(CRP)升高,CD4+/CD8+、CD4+降低是老年2型糖尿病合并CAP患者死亡的独立危险因素(P<0.05,P<0.01)。结论老年2型糖尿病合并CAP患者病原菌分布较广,以革兰阴性菌为主。机械通气、慢性肾脏病、PSI评分≥130分、脓毒症、HbA1c>8.0%、WBC>10×10^(9)/L,血乳酸、血肌酐、CRP升高,CD4+/CD8+、CD4+降低均为老年2型糖尿病合并CAP患者死亡的独立危险因素。

Objective To investigate the etiological characteristics and risk factors of death in elderly patients with type 2 diabetes mellitus(T2DM)complicated with community-acquired pneumonia(CAP).Methods The case data of 190 elderly patients with T2DM combined with CAP admitted from April 2021 to April 2023 were retrospectively analyzed and divided into death group and survival group according to the prognosis in hospital.The pathogenic bacteria distribution characteristics and clinical data of the two groups were compared,and the risk factors of death in elderly patients with T2DM combined with CAP were analyzed by multivariate Logistic regression analysis.Results Among 190 elderly patients with T2DM combined with CAP,159(83.68%)patients survived in hospital,and there were 31 deaths(16.32%).The pathogenic bacteria detected included 164 gram-negative bacteria,94 gram-positive bacteria and 9 fungi,accounting for 61.42%,35.21%and 3.37%,respectively.Additionally,53 strains of Acinetobacter baumannii,46 strains of Klebsiella pneumoniae,46 strains of Staphylococcus aureus,32 strains of Streptococcus pneumoniae and 24 strains of Pseudomonas aeruginosa were detected,accounting for 19.85%,17.23%,17.23%,11.99%and 8.99%of the total pathogens,respectively.The infection rates of Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae,and mixed bacteria in death group were higher than those in survival group(P<0.05).Mechanical ventilation,chronic kidney disease,pneumonia severity index(PSI)score≥130 points,sepsis,hemoglobin A1c(HbA1c)>8.0%,white blood cell count(WBC)>10×10^(9)/L,as well as elevated blood lactic acid,serum creatinine(Scr),C-reactive protein(CRP),and decreased CD4+/CD8+and CD4+,were independent risk factors for death in elderly patients with T2DM and CAP(P<0.05,P<0.01).Conclusion In elderly patients with T2DM combined with CAP,the pathogenic bacteria are widely distributed,mainly gram-negative bacteria.Mechanical ventilation,chronic kidney disease,PSI score≥130,sepsis,HbA1c>8.0%,WBC>10×10^(9)/L,as well as elevated serum lactate,Scr,CRP,and decreased CD4+/CD8+and CD4+were all independent risk factors for death in elderly patients with T2DM combined with CAP.