老年重症肺炎病原菌及其影响因素

目的探讨老年重症肺炎病原菌及其影响因素。方法回顾性分析2016年11月-2019年12月海南省儋州市中医医院收治的老年肺部感染患者269例,分为重症肺炎组和非重症肺炎组,收集患者临床资料和临床症状,采集痰液标本进行病原菌检查、药敏试验。结果重症肺炎发生率27.14%(73/269)。血氧分压降低为最常见临床表现(76.71%)。痰液标本分离出104株病原菌,革兰阴性菌76株(73.08%),最常见为铜绿假单胞菌(26.92%)。铜绿假单胞菌对氨苄西林的耐药率96.43%,不动杆菌属对氨苄西林的耐药率100.00%。老年重症肺炎和老年非重症肺炎患者在年龄、多脏器功能受损、合并慢性阻塞性肺疾病(COPD)、出现意识障碍具有统计学差异(P<0.05)。年龄、多脏器功能受损、合并COPD、出现意识障碍、糖尿病,均成为老年肺部感染重症的独立危险因素(P<0.05)。结论老年重症肺炎患者临床症状表现不十分典型,革兰阴性菌是老年重症肺炎的主要致病菌而且耐药率高。年龄、多脏器功能受损,合并COPD、意识障碍、糖尿病,是老年肺部感染成为重症的独立危险因素,可针对这些患者采取针对性的措施进行防范和干预。

Influencing factors for pathogenic bacteria infections in elderly patients with severe pneumonia

OBJECTIVE To explore the influencing factors for pathogenic bacteria infections in the elderly patients with severe pneumonia.METHODS A total of 269 elderly patients with pulmonary infection who were treated in Danzhou Hospital of Traditional Chinese Medicine from Nov 2016 to Dec 2019 were retrospectively analyzed and were divided into the severe pneumonia group and the non-severe pneumonia group.The clinical data and clinical symptoms were collected from the patients,and the sputum specimens were collected for culture of pathogens and drug susceptibility testing.RESULTS The incidence of severe pneumonia was 27.14%(73/269).The declined blood oxygen partial pressure was the most common clinical manifestation(76.71%).Totally 104 strains of pathogens were isolated from the sputum specimens,76(73.08%)of which were gram-negative bacteria,and Pseudomonas aeruginosa(26.92%)was the predominant species of the gram-negative bacteria.The drug resistance rate of the P.aeruginosa strains to ampicillin was 96.43%,the drug resistance rate of the Acinetobacter spp to ampicillin was 100.00%.There were significant differences in the age,damage of multiple organ function,complication with chronic obstructive pulmonary disease(COPD)and disturbance of consciousness between the severe pneumonia group and the non-severe pneumonia group(P<0.05).The age,damage of multiple organ function,complication with COPD,disturbance of consciousness and diabetes mellitus were the independent risk factors for the severe pulmonary infection(P<0.05).CONCLUSION The clinical symptoms of the elderly patients with severe pneumonia are not very typical.The gram-negative bacteria are dominant among the pathogens isolated from the elderly patients with severe pneumonia and highly drug-resistant.The age,damage of multiple organ function,complication with COPD,disturbance of consciousness and diabetes mellitus are the independent risk factors for the severe pulmonary infection in the elderly patients.It is necessary to take targeted prevention interventions.