老年重症肺炎病原菌与死亡影响因素分析

Analysis of pathogens and risk factors for death in elderly patients with severe pneumonia

目的探讨和分析老年重症肺炎患者病原菌与死亡的影响因素。方法选取2015年1月-2017年2月医院所收治的268例老年重症肺炎患者为研究对象,并分别对老年重症肺炎患者的病原菌与耐药情况进行分析,分析患者性别、年龄、基础疾病等临床资料归纳老年重症肺炎患者死亡的影响因素。结果 268例老年重症肺炎患者共培养分离病原菌313株,其中革兰阴性菌197株占62.94%,以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主;革兰阳性菌90株占28.75%,以金黄色葡萄球菌、肺炎链球菌为主;真菌26株占8.31%,以白假丝酵母为主。主要革兰阴性菌对氨苄西林和头孢吡肟耐药率较高;而对亚胺培南和美罗培南较敏感;主要革兰阳性菌对青霉素和红霉素耐药率较高,而对万古霉素较敏感。268例老年重症肺炎患者最终死亡52例,死亡率为19.40%。年龄、急性生理学及慢性健康状况评分(APACHEⅡ)、合并基础疾病及应用抗菌药物是老年重症肺炎患者死亡的影响因素(P<0.05)。结论老年重症肺炎患者病原菌以革兰阴性菌为主,临床应根据其病原菌特点和影响因素及时采取针对性的干预措施。

OBJECTIVE To probe into the pathogens and risk factors for death in elderly patients with severe pneumonia.METHODS 268 elderly patients with severe pneumonia From treated in the hospital during Jan.2015 to Feb.2017 were enrolled in the study.The pathogens and drug resistance in elderly patients with severe pneumonia were analyzed.The clinical data such as genders,age and underlying diseases were analyzed,and the risk factors of death in elderly patients with severe pneumonia were summarized.RESULTS A total of 313 strains of pathogens were cultured and isolated from the 268 elderly patients with severe pneumonia.There were 197 strains of gramnegative bacteria,accounting for 62.94%,mainly Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae,90 strains of gram-positive bacteria,accounting for 28.75%,mainly Staphylococcus aureus and Streptococcus pneumonia,and 26 strains of fungi,accounting for 8.31%,mainly Candida albicans.The main gram-negative bacteria showed relatively high resistance to ampicillin and cefepime,but were relatively sensitive to imipenem and meropenem.The main gram-positive bacteria showed relatively high resistance rates to penicillin and erythromycin,but were relatively sensitive to vancomycin.In the 268 elderly patients with severe pneumonia,52 cases eventually died.The death rate was 19.40%.The age,acute physiology and chronic health evaluation scoring system(APACHE II),combined underlying diseases and antibiotics were the risk factors of death in elderly patients with severe pneumonia(P <0.05).CONCLUSION Gram-negative bacteria were main pathogens in elderly patients with severe pneumonia.Targeted intervention measures should be taken in clinic according to the characteristics of the pathogens and risk factors.