高龄医院获得性肺炎患者多重耐药菌的分布及临床特点

目的探究高龄医院获得性肺炎患者多重耐药菌(MDROs)的分布及临床特点,为制定防控对策提供依据。方法采用回顾性调查方法,选取2018年1月至2019年12月在联勤保障部队第904医院常州医疗区内科收治的高龄医院获得性肺炎患者共82例,采集患者深部痰标本分离培养,依据药敏耐药性分为MDROs组(n=42)和非MDROs组(n=40)。分析MDROs的分布与临床特点,对比2组患者临床指标的差异,分析MDROs感染的危险因素。采用SPSS 22.0统计软件进行数据处理,依据数据类型,组间比较采用t检验或χ2检验。多因素非条件logistic回归分析MDROs感染的危险因素。结果MDROs组以铜绿假单胞菌、鲍曼不动杆菌多见,呼吸机相关性肺炎(VAP)发生率和死亡率(观察6~12个月)MDROs组高于非MDROs组。多因素非条件logistic回归分析显示,年龄(OR=1.147,95%CI 1.029~1.279;P=0.013)、住院时间长(OR=1.139,95%CI 1.049~1.238;P=0.002)、抗菌药物使用时间长(OR=1.081,95%CI 1.014~1.153;P=0.017)、有创机械通气时间长(OR=1.172,95%CI 1.029~1.334;P=0.016)及C-反应蛋白(CRP)升高(OR=1.144,95%CI 1.047~1.250;P=0.003)为高龄医院获得性肺炎患者MDROs感染的独立危险因素。结论高龄医院获得性肺炎患者MDROs多见铜绿假单胞菌、鲍曼不动杆菌,VAP发生率和死亡率高。

Distribution and clinical characteristics of multidrug-resistant organisms in elderly patients with hospital-acquired pneumonia

Objective To investigate the distribution and clinical characteristics of multidrug-resistant organisms(MDROs)in the elderly patients with hospital-acquired pneumonia(HAP)to provide the basis for formulating prevention and control strategies.Methods A retrospective survey was conducted among 82 elderly HAP patients admitted to the Department of Internal Medicine of Joint Service Support Force Hospital No.904 from January 2018 to December 2019.Deep sputum specimens were collected for bacterial isolation and culture.The patients were divided into MDROs group(n=42)and non-MDROs group(n=40).Distribution and clinical characteristics of MDROs specimens were analyzed.The two groups were compared in clinical indicators,and analysis was performed for the risk factors of MDROs infection.SPSS statistics 22.0 was used for data processing.Depending on data type,t-test orχ2 test was performed for comparison between groups,and multivariate unconditional logistic regression for investigation of independent risk factors of MDROs infection.Results Infections by pseudomonas aeruginosa and acinetobacter baumannii were more common in MDROs group.Incidence and mortality of ventilator-associated pneumonia were higher in MDROs group than in non-MDROs group.Multivariate unconditional logistic regression showed that age(OR=1.147,95%CI 1.029-1.279;P=0.013),long hospital stay(OR=1.139,95%CI 1.049-1.238;P=0.002),long antibiotic use(OR=1.081,95%CI 1.014-1.153;P=0.017),prolonged use of the invasive ventilator(OR=1.172,95%CI 1.029-1.334;P=0.016),and C-reac tive protein(CRP)(OR=1.144,95%CI 1.047-1.250;P=0.003)were independent risk factors of MDROs infection.Conclusion Pseudomonas aeruginosa and acinetobacter baumannii are common pathogens in the elderly patients with hospital-acquired pneumonia with high incidence and mortality rate of ventilator-associated pneumonia.