老年患者骨关节术后肺部感染病原菌分布和耐药性及危险因素研究

Distribution and drug resistance and risk factors of pathogen in elderly patients with pulmonary infection after osteoarthroplasty

目的了解老年患者骨关节术后肺部感染病原菌分布、耐药性及其危险因素。方法通过Whonet数据处理软件回顾性分析老年患者骨关节术后肺部感染患者痰标本中的病原菌分布特征及耐药性,以单因素和多因素Logistic回归分析筛选出肺部感染的危险因素。结果共监测2016年1月-2018年1月某院骨关节术老年患者638例,肺部感染发生率为5. 02%;共分离出病原体63株,其中革兰阳性菌、革兰阴性菌和真菌分别占34. 9%、61. 9%和3. 2%。革兰阳性菌对利奈唑胺、万古霉素和替加环素高度敏感,对青霉素G和红霉素的耐药率较高;革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南敏感率较高,对氨苄西林、头孢唑啉和头孢曲松的耐药率较高。患者长期吸烟、住院时间≥15 d、并发糖尿病、慢性呼吸系统疾病、全身麻醉、手术时间≥3 h、使用糖皮质激素、留置导尿管和机械通气均为肺部感染的危险因素(P <0. 05);长期吸烟、住院时间≥15 d、慢性呼吸系统疾病、全身麻醉和使用糖皮质激素为肺部感染的独立危险因素(P <0. 05)。结论临床医师应加强老年骨关节手术患者病原菌及肺部感染监测,合理使用抗菌药物,有效预防与控制老年患者术后肺部感染。

Objective To understand the distribution,drug resistance and risk factors of pathogen in elderly patients with pulmonary infection after osteoarthroplasty.Methods The distribution and drug resistance of pathogenic bacteria in sputum specimens of elderly patients with pulmonary infection after osteoarthroplasty were retrospectively analyzed by Whonet data processing software.The risk factors of pulmonary infection were screened by univariate and multivariate Logistic regression analysis.Results A total of 638 elderly patients undergoing osteoarthroplasty in a hospital from January 2016 to January 2018 were monitored,and the incidence of pulmonary infection was 5.02%.63 strains of pathogens were isolated,of which 34.9%were Gram-positive bacteria,61.9%were Gram-negative bacteria and 3.2%were fungi,respectively.Gram-positive bacteria were highly sensitive to linezolid,vancomycin and tegacycline,and were resistant to penicillin G and erythromycin.The susceptibility rate of Gram-negative bacteria to cefoperazone/sulbactam and imipenem was higher,and the resistance rate to ampicillin,cefazolin and ceftriaxone was higher.The risk factors of pulmonary infection were long-term smoking,hospitalization time>15 days,diabetes mellitus,chronic respiratory diseases,general anesthesia,operation time>3 h,glucocorticoid use,indwelling urinary catheter and mechanical ventilation(P<0.05).Long-term smoking,hospitalization time>15 days,chronic respiratory diseases,general anesthesia and glucocorticoid use were independent risk factors for pulmonary infection(P<0.05).Conclusion Clinicians should strengthen the surveillance of pathogenic bacteria and pulmonary infection in elderly patients undergoing osteoarthroplasty,rationally use antibiotics,and effectively prevent and control pulmonary infection in elderly patients after operation.