老年社区获得性肺炎住院患者耐药菌感染危险因素分析  

Analysis on hazard factors for drug-resistance bacterial infection of CAP of senile ones

作　　者：孟小蓉[1] 孙春丽 王丽平[1] 张磊[1] 孟丹丹[2] Meng Xiaorong;Sun Chunli;Wang Liping;Zhang Lei;Meng Dandan(Department of Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China;Department of Pharmacy, Mianyang Central Hospital, Mianyang, Sichuan, 421000, China)

机构地区：[1]成都医学院第一附属医院老年科,成都610500 [2]绵阳市中心医院药剂科

出　　处：《西南国防医药》2018年第3期296-299,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨老年社区获得性肺炎(CAP)住院患者耐药菌分布特点及危险因素。方法回顾性分析261例CAP患者病原菌检测结果,并运用Logistic回归分析耐药菌感染的危险因素。结果共分离135株病原菌,前3位分别是:65~74岁患者为肺炎链球菌(22.72%)、肺炎克雷伯杆菌(19.69%)、肺炎链球菌合并肺炎支原体(15.15%);≥75岁患者为肺炎克雷伯杆菌(28.98%)、肺炎链球菌(15.94%)、流感嗜血杆菌(11.59%);耐药菌58株,革兰氏阴性菌32株(55.17%),革兰氏阳性菌26株(44.83%),其中肺炎链球菌占比例最高,为27.59%,其次为肺炎克雷伯杆菌、流感嗜血杆菌、耐甲氧西林金黄色葡萄球菌、铜绿假单胞菌。与老年CAP住院患者耐药菌感染显著关联的危险因素是住院≥3次/年、长期卧床、不规则使用抗生素、不规则使用质子泵抑制剂、脑卒中史。结论老年CAP住院患者耐药菌感染危险因素多,充分评估、加强监测有利于降低经验性抗生素选择的失败率,也有利于耐药菌的预防和控制。Objective To explore the distribution behaviors and hazard factors of drug-resistance bacterial infection of Community acquired pneumonia（CAP） senile ones. Methods Retrospective analysis was made on the results of pathogen detection for 261 CAP patients. Logistics regression was applied in analyzing the hazard factors for drug-resistance bacterial infection. Results A total of 135 strains of pathogenic bacteria were separated, among which the top three bacteria were respectively streptococcus pneumoniae（22.72%）, klebsiella pneumoniae（19.69%） and streptococcus pneumoniae complicated with mycoplasma pneumoniae（15.15%） for patents aged 65-74, and klebsiella pneumoniae（28.98%）, streptococcus pneumoniae（15.94%） and haemophilus influenzae（11.59%）for patients aged ≥ 75. There were 58 strains of drug-resistance bacteria, 32 strains of Gram-negative bacteria（55.17%） and 26 strains of Gram-positive bacteria（44.83%）, in which streptococcus pneumoniae was the most dominant bacterium（27.59%）, followed by klebsiella pneumoniae, haemophilus influenzae, methicillin-resistant staphylococcusaureus and pseudomonas aeruginosa in sequence.The hazard factors clearly correlated to drug-resistance bacterial infection of CAP of the senile ones involved a hospitalization frequency ≥ 3 times per year, long-term bedridden, irregular administration of antibiotics, irregular use of proton-pump inhibitors and a history of cerebral apoplexy. Conclusion There are several hazard factors for drug-resistance bacterial infection of CAP of senile ones. Appropriate and comprehensive assessment and enhanced monitoring can reduce the failure rate of experience-based use of antibiotics and attribute to better prevention and control of drug-resistance bacteria.

关 键 词：老年 住院 社区获得性肺炎 耐药菌 危险因素 

分 类 号：R446[医药卫生—诊断学]