耐甲氧西林金黄色葡萄球菌医院获得性肺炎老年患者的流行趋势及危险因素分析  

Analysis of epidemiology and risk factors of hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia in senile patients

作　　者：李向阳[1] 徐轶[1] 瞿介明[1] 

机构地区：[1]复旦大学附属华东医院呼吸科,上海200040

出　　处：《上海医学》2013年第1期30-32,共3页Shanghai Medical Journal

基　　金：上海市医学会临床医学科研专项资金资助项目(SMJ2010009)

摘　　要：目的了解耐甲氧西林金黄色葡萄球菌(MRSA)医院获得性肺炎(HAP)老年患者的流行趋势、临床特点、相关危险因素及细菌耐药性。方法采用病例对照研究的方法,60例MRSAHAP老年患者入选MRSA组,52例甲氧西林敏感金黄色葡萄球菌(MSSA)HAP老年患者入选MSSA组,通过回顾性分析患者的基本情况,分析发病的危险因素及临床特点,并对分离到的菌株进行药物敏感试验。结果 2009、2010、2011年的下呼吸道MRSA检出率有逐年上升的趋势,但差异无统计学意义(P>0.05)。药物敏感试验结果示MRSA呈多重耐药。MRSA组的平均年龄、住院时间均显著高于MSSA组(P值均<0.01)。MRSA组的糖尿病、脑卒中和慢性肺部疾病的构成比均显著高于MSSA组(P值分别<0.01、0.05)。MRSA组住院期间应用静脉导管、使用≥2种抗生素及广谱抗生素使用时间>14d的构成比均显著高于MSSA组(P值分别<0.01、0.05)。结论老年患者中,住院时间长、糖尿病、脑卒中、长期使用广谱抗生素可能是医院内MRSA感染的危险因素。Objective To study the epidemiology, clinical features, risk factors and dn）g resistance of hospital-acquired methicillin-resistant Staphylococcus aureus （HA-MRSA） pneumonia in senile patients. Methods In the case-control study, the senile patients with HA-MRSA pneumonia were assigned to MRSA group, and the senile patients with hospital-acquired methicillin- sensitive Staphylococcus aureus （MSSA） pneumonia were taken as MSSA group. Patient＇s general condition, risk factors of morbidity and clinical features were retrospectively analyzed. The drug sensitivity tests were performed for isolated bacteria . Results The detection rates of MRSA in lower respiratory airway increased in the latest 3 years, but the difference was not statistically significant （P〉0.05）. The drug sensitivity tests showed that MRSA was multiple-drug-resistant. The average age and hospital stay in MRSA group were significantly older and longer than those in MSSA group （both P〈0.01 ）. The incidences of diabetes, stroke and chronic lung disease in MRSA group were significantly higher than those in MSSA group （P〈0.05 or 〈0.01）. Compared with MSSA group , there were more patients in MRSA group in whom 2 or more antibiotics were used, broad-spectrum antibiotics were applied more then 14 d, or intravenous catheter procedure was performed （P〈0.05 or G0.01 ）. Conclusion Long hospital stay, diabetes, stroke, and long-term use of broad-spectrum antibiotics may be the risk factors of HA-MRSA pneumonia in senile patients.

关 键 词：耐甲氧西林金黄色葡萄球菌 医院获得性肺炎 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]