老年慢性支气管炎急性期住院患者多重耐药菌感染的相关因素

Factors associated with multi-drug-resistant bacterial infections in elderly inpatients with acute attack of chronic bronchitis

摘要:

目的 分析老年慢性支气管炎急性期住院患者多重耐药菌(MDROs)感染影响因素,为临床防控提供参考。方法 纳入2015年9月至2019年5月收治的313例老年慢性支气管炎急性期患者,对其临床资料进行回顾性分析。分析其MDROs的感染率及感染菌株分布。对其MDROs感染影响因素进行单因素和多因素回归分析。采用SPSS 19.0软件包进行统计分析,利用单因素和多因素logistic回归模型分析老年慢性支气管肺炎急性期住院患者MDROs感染独立影响因素。结果 313例老年慢性支气管炎急性期住院患者中共有107例患者检出MDROs,感染率34.19％。临床标本中共分离出病原菌301株,其中MDROs 118株,占39.20%。单因素分析显示年龄≥70岁、糖尿病病史、入院前近6个月联合使用抗菌药物≥3种、住院时间≥14d、并发肺源性心脏病、入住重症监护病房(ICU)、糖化血经蛋白(>7%)、入院后抗菌药物使用种类≥3种、入院后联合使用抗菌药物≥3种、血糖值≥11.1mmol/L、入院后抗菌药物使用时间＞7d均是老年慢性支气管炎急性期住院患者MDROs感染危险因素(P＜0.05),而口腔护理与雾化吸入是老年慢性支气管炎急性期住院患者MDROs感染保护因素(P＜0.05)。多因素logistic 回归分析结果表明年龄≥70岁、入院前近6个月联合使用抗菌药物≥3种、入住ICU、糖化血红蛋白＞7%、入院后联合使用抗菌药物≥3种等是MDROs感染独立危险因素(P＜0.05)。结论 老年慢性支气管炎急性期住院患者MDROs感染与多种因素有关,控制血糖、减少并发肺源性心脏病、关注患者入院前近期联用抗菌药物情况、减少不必要入住ICU、合理使用抗菌药物等为主的综合措施,可降低其MDROs感染率。

Abstract:

Objective To analyze affecting factors of multidrug-resistant (MDR) bacterial infection in elderly patients with acute attack of chronic bronchitis with a view of providing reference for clinical prevention and control. Methods The clinical data were retrospectively reviewed of 313 elderly patients with acute attack of chronic bronchitis from September 2015 to May 2019. Infection rate and distribution of infectious strains were analyzed. SPSS statistics 19.0 was used for statistical analysis. Univariate and multivariate regression analysis were performed to identify independent affecting factors of MDR bacterial infections in elderly inpatients with acute attack of chronic bronchitis. Results Of 313 elderly inpatients with acute attack of chronic bronchitis, MDR bacterial infection was detected in 107(34.19%). A total of 301 pathogenic bacteria were isolated from clinical specimens, 118(39.20%) being multidrug resistant. Univariate analysis showed that age ≥70 years, history of diabetes mellitus, combined use of antibiotics ≥ 3 kinds in the past 6 months before admission, length of hospital stay ≥ 14d, pulmonary heart disease, admission to Intensive Care Unit (ICU), glycosylated blood protein >7%, types of antibiotics ≥ 3 kinds after admission, combined use of antibiotics after admission ≥ 3 kinds,fasting blood glucose ≥ 11.1mmol/L, the time of using antibiotics after admission > 7d were the risk factors of MDROs infectionin elderly patients with chronic bronchitis at acute stage (P<0.05), while oral care and aerosol inhalation were the protective factors of MDROs infection in elderly patients with chronic bronchitis at acute stage (P<0.05). Multivariate logistic regression analysis showed that the independent risk factors of MDROs infection were age>70 years, combined use of antibiotics>3 kinds within 6 months before admission, admission to ICU, glycosylated menstrual protein>7%, and combining used antibiotics>3 kinds after admission (P<0.05). Conclusion MDR bacterial infection in elderly inpatients with acute attack of chronic bronchitis is associated with many factors, and infection rate can be reduced by controlling blood sugar, reducing complications of pulmonary heart disease, paying attention to the recent use of antibiotics before admission, reducing unnecessary admission to ICU, and rational use of antibiotics.