医院获得性铜绿假单胞菌肺炎危险因素分析

目的分析医院获得性铜绿假单胞菌肺炎的危险因素，指导初始经验性抗菌治疗。 方法选择空军军医大学第二附属医院2019年1月至2019年6月的所有医院获得性革兰阴性杆菌肺炎(GNB-HAP)患者374例，根据细菌培养结果分为医院获得性铜绿假单胞菌肺炎组(PA-HAP)81例，医院获得性非铜绿假单胞菌肺炎组(non-PA-HAP)293例，在获得呼吸道合格标本当天对变量进行评估，将单因素分析P<0.05的自变量纳入多因素Logistic回归分析，找到因变量的危险因素。 结果在单因素分析中，与PA-HAP相关的潜在危险因素包括呼吸道标本收集日期距离住院日的天数、未入住ICU、未接受脑科手术、无颅腔引流管、无昏迷、无误吸风险、无脑梗塞、无脑出血、胸科手术、留置胸腔引流管、布地奈德吸入、肿瘤、脾切除术。多因素Logistic回归分析确定PA-HAP的独立危险因素：胸科手术adjusted odds ratio (aOR) 2.462, 95%CI 1.237~4.900]、无昏迷(2.516, 1.368~4.627)、布地奈德吸入(1.883, 1.049~3.393)、脾切除术(5.039 , 1.051~24.154)。 结论住院期间伴有胸科手术、吸入布地奈德、脾切除术而无昏迷的GNB-HAP患者应警惕铜绿假单胞菌感染。

Risk factorsanalysis for hospital-acquired pneumonia caused by Pseudomonas aeruginosa

ObjectiveTo analyze the risk factors of hospital-acquired pneumonia caused by Pseudomonas aeruginosa, so as to guide the initial empirical antimicrobial treatment. MethodsAll of 374 patients with hospital acquired pneumonia caused by Gram-negative bacilli(GNB-HAP) in our hospital during January 2019 to June 2019 were included in the study. Patients were divided into hospital acquired Pseudomonas aeruginosa pneumonia group (81 cases) and hospital acquired non-Pseudomonas aeruginosa pneumonia group (293 cases) according to whether the bacterial culture results were Pseudomonas aeruginosa. The variables were assessed on the day when qualified respiratory specimens were obtained. Variables with a P<0.05 in univariable analysis were then included in the multivariablelogistic regression analysis to find the independent risk factor of PA-HAP. ResultsThe potential risk factors associated with PA-HAP in the univariate analysiswere Days from the specimens collection date to the date in hospital; no admission to ICU, no Cerebral surgery, no cranial drainage, no coma, no risk of aspiration, no cerebral infarction, no cerebral hemorrhage, thoracic surgery; thoracic drainage; budesonide inhalation; tumor; splenectomy. Theindependent risk factors of PA-HAP determined by multivariate logistic regression analysis included thoracic surgery adjusted odds ratio (aOR) 2.462, 95%CI 1.237~4.900]; no coma(2.516, 1.368~4.627); budesonide inhalation (1.883, 1.049~3.393); splenectomy (5.039, 1.051~24.15). ConclusionsPseudomonas aeruginosa infection should be on alert in patients with GNB-HAP who have thoracic surgery, inhaled budesonide, splenectomy and no coma during hospitalization.