老年心力衰竭患者的社区获得性肺炎病原菌分布及危险因素分析

Pathogen distribution in and risk factors for community-acquired pneumonia in the elderly patients with heart failure

摘要:

目的 探讨老年心力衰竭患者的社区获得性肺炎(CAP)病原菌分布及危险因素分析。方法 入选2015年1月至2016年5月就诊于合肥市妇幼保健院的老年心力衰竭患者60例作为研究组。另选取同期就诊的由其他非感染诱因导致心力衰竭恶化的患者43例作为对照组。收集所有患者的临床资料及SF-36健康调查量表评分。采集研究组患者的痰液标本,分离培养检定病原菌并进行药敏试验。采用SPSS 23.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ²检验。使用logistic回归分析影响CAP发生的危险因素。结果 60例CAP患者中,共培养出病原体71株,其中革兰阴性菌43株(60.6%),革兰阳性菌21株(29.6%),真菌7株(9.9%)。革兰阴性菌对喹诺酮类、第三代头孢菌素的耐药性较高,对亚胺培南的敏感性较高。革兰阳性菌对青霉素、克林霉素普遍耐药,对万古霉素的敏感性较高。logistic回归分析提示,吸烟史(OR=2.91,95%CI 1.13～7.44,P=0.026)和SF-36健康调查量表总评分(OR=0.98,95%CI 0.97～0.99,P<0.001)低是老年心力衰竭患者发生CAP的危险因素(P<0.05)。结论 老年心力衰竭患者的CAP病原菌分布以革兰阴性菌为主,且对头孢菌素和喹诺酮类耐药性较高。吸烟、基础生活质量差是老年心力衰竭患者发生CAP的危险因素。

Abstract:

Objective To investigate the pathogen distribution in and risk factors for community-acquired pneumonia (CAP) in the elderly patients with heart failure (HF). Methods Sixty elderly patients with HF admitted to Hefei Women and Child Healthcare Hospital from January 2015 to May 2016 were included as study group, and the control group were forty-three patients with HF wor-sened by non-infectious factors admitted to the hospital during the same period. The clinical data and SF-36 health survey scale scores were collected for all patients. Sputum samples were collected and culture-based diagnosis and drug-resistance testing were performed. Statistical analysis was performed using SPSS statistics 23.0, t-test or χ² test was used for the comparison between groups according to the data type. Logistic regression analysis was conducted to explore the risk factors for CAP. Results In 60 patients with CAP, 71 strains of pathogens were isolated, of which 43(60.6%) were Gram-negative bacteria, 21(29.6%) Gram-positive bacteria, and 7(9.9%) fungi. The main Gram-negative bacteria had high rates of resistance to quinolones and third-generation cephalosporins but were sensitive to imipenem. Gram-positive bacteria were generally resistant to penicillin and clindamycin but sensitive to vancomycin. Logistic regression analysis showed that both smoking (OR 2.91, 95%CI 1.13-7.44; P=0.026) and poor quality of life at baseline (OR=0.98, 95%CI 0.97-0.99; P<0.001) were the risk factors for CAP (P<0.05). Conclusion CAP in elderly patients with HF was mainly caused by Gram-negative bacteria, which are resistant to cephalosporins and quinolones. Smoking and poor quality of life at baseline are risk factors for CAP in the elderly patients with HF.