老年坠积性肺炎多重耐药菌感染相关因素分析

Related factors of multiple drug resistant infection in aged patients with hypostatic pneumonia:analysis of 622 cases

摘要:

目的 分析老年坠积性肺炎患者多重耐药菌(MDRB)感染的相关危险因素,为临床诊治提供参考。方法 回顾性分析2012年2月至2018年7月贵州医科大学第三附属医院老年住院坠积性肺炎患者622例,根据是否从其临床感染标本中分离出MDRB菌株,分为MDRB组与非MDRB组,对MDRB感染的相关危险因素进行分析。应用SPSS 20.0统计软件对数据进行分析。组间比较用χ²检验。单因素和多因素logistic回归分析MDRB感染的危险因素。结果 老年坠积性肺炎MDRB感染率34.43%(167/485)。单因素分析显示年龄(＞70岁)、慢性肺部感染史、慢性心脑血管病病史、糖尿病病史、病程(＞15 d)、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分＞20分、昏迷、吸烟史、抗菌药物使用时间(＞7 d)、抗菌药物使用种类(≥3种)、血糖(≥11.1 mmol/L)等是老年坠积性肺炎MDRB感染的危险因素(P＜0.05),而半坐卧位、雾化吸入与口腔护理是感染保护因素(P＜0.05)。logistic回归分析显示慢性肺部感染史(OR＝3.472,5%CI 1.866~6.461; P＝0.000)与联合使用抗菌药物(≥3种)(OR＝3.760,5%CI 1.775~7.968; P＝0.038)是老年坠积性肺炎MDRB感染的独立危险因素,雾化吸入(OR＝0.624,5%CI 0.400~0.974; P＝0.000)与口腔护理(OR=0.256,5%CI 0.161~0.408; P＝0.001)是老年坠积性肺炎MDRB感染的保护因素。结论 老年坠积性肺炎MDRB感染与多种因素相关,临床应重点关注慢性肺部感染患者,合理使用抗菌药物,同时做好口腔护理,采取雾化吸入排痰等综合措施可减少MDRB感染。

Abstract:

Objective To analyze the risk factors of multiple drug resistant bacteria (MDRB) infection in the elderly patients with hypostatic pneumonia in order to provide reference for clinical diagnosis and treatment. Methods A retrospective analysis was carried out on 622 elderly hospitalized patients with pendulous pneumonia admitted in the Third Affiliated Hospital of Guizhou Medical University from February 2012 to July 2018. According to whether the strains of MDRB were isolated from their clinical infection specimens, they were divided into MDRB group and non-MDRB group. SPSS statistics 20.0 was used to perform the statistical analysis. Chi-square test was employed for intergroup comparison. The risk factors of MDRB infection were analyzed with univariate and multivariate logistic regression analyses. Results The infection rate of MDRB was 34.43%(167/485). Univariate analysis showed that age (>70 years), history of chronic pulmonary infection, history of chronic cardio-cerebrovascular disease, history of diabetes mellitus, course of disease (>15 d), APACHE Ⅱ score >20, coma, smoking history, and time of antibiotic usage (>7 d), types of applied antibiotics (≥3) and blood glucose (≥11.1 mmol/L) were the risk factors of MDRB infection in the elderly (P<0.05). Semi-sitting position, aerosol inhalation and oral nursing were the protective factors of the infection (P<0.05). Logistic regression analysis presented that the history of chronic pulmonary infection (OR=3.472,5%CI 1.866-6.461; P=0.000) and combined use of antimicrobial agents (≥3) (OR=3.760,5%CI 1.775-7.968; P=0.038) were independent risk factors for MDRB infection. Aerosol inhalation (OR=0.624, 95%CI0.400-0.974;P=0.000) and oral care (OR=0.256,5%CI0.161-0.408; P=0.001) were the protective [JP+1]factors of MDRB infection in the aged patients with pendulous pneumonia. Conclusion MDRB infection in elderly patients with pendulous pneumonia is related to many factors. Clinical attention should be paid to these patients, and rational use of antimicrobial agents, oral care and comprehensive measures such as aerosol inhalation and sputum drainage can reduce the infection of MDRB.