高龄肺部感染患者多重耐药菌的分布及临床特点

Distribution and clinical characteristics of multidrug-resistant bacteria in the elderly patients with pulmonary infection

摘要:

目的 探讨高龄肺部感染患者多重耐药菌(MDR)的分布及临床特点。方法 入选2015年1月至2016年12月在西京医院老年病科住院治疗的高龄肺部感染患者共219例。依据是否出现MDR分为2组:MDR组(n＝107)和非MDR组(n＝112)。分析MDR的分布情况,并比较2组患者的各临床指标,分析MDR感染的危险因素。采用SPSS 18.0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。多因素logistic回归分析发生MRA感染的独立危险因素。结果 MDR组以鲍曼不动杆菌、铜绿假单胞菌等细菌感染多见。MDR组患者1年死亡率较对照组明显升高[30.2%(32/106) vs 8.0%(9/112);P＜0.05]。多因素logistic回归分析结果提示,住院时间长(OR=4.813,95%CI 1.234~5.554；P=0.032)、抗生素使用时间长(OR=3.124,95%CI 2.126~10.314；P=0.001)及有创呼吸机使用时间长(OR=4.227,95%CI 1.470~6.879；P=0.041)是发生MDR感染的独立危险因素。结论 高龄肺部感染MDR以鲍曼不动杆菌和铜绿假单胞菌感染多见。发生MDR感染的患者死亡率高,住院时间长、抗生素时间长、有创呼吸机使用时间长是其发生的独立危险因素。

Abstract:

Objective To investigate the distribution and clinical characteristics of multidrug-resistant (MDR) bacteria in the elderly patients with pulmonary infection. Methods Included in the study were 219 elderly patients with pulmonary infection attending the Department of Geriatrics of Xijing Hospital from January 2015 to December 2016. They were divided into MDR group (n=107) and non-MDR group (n=112) based on the presence of MDR bacteria. An analysis was made of the distribution of MDR bacteria in the former, the two groups were compared in the clinical indicators of the patients, and the risk factors were investigated for MDR infection. SPSS statistics 18.0 was used for data processing. Depending on data type, t-test or χ² test was performed for comparison between groups, and multivariate logistic regression for investigation of independent risk factors for MDR infection. Results Infections by Acinetobacter baumannii and Pseudomonas aeruginosa were more common in the MDR group. One-year mortality was significantly higher in the MDR group than that in the non-MDR group [30.2%(32/106) vs 8.0%(9/112), P<0.05]. Multivariate logistic regression showed that long hospital stay (OR=4.813,5%CI 1.234-5.554; P=0.032), long antibiotics medication (OR=3.124, 95%CI 2.126-10.314; P=0.001) and prolonged use of the invasive ventilator (OR=4.227,5%CI 1.470-6.879; P=0.041) were independent risk factors for the MDR infection. Conclusion Pulmonary MDR infections in the elderly are mostly caused by Acinetobacter baumannii and Pseudomonas aeruginosa. Patients with MDR infections have high mortality. Long hospitalization, long antibiotic medication, and prolonged use of the invasive ventilators are independent risk factors for MDR infections.