老年冠心病合并心力衰竭患者医院感染的病原学特点及危险因素分析  

Etiological characteristics and risk factors of nosocomial infection in elderly patients with coronary artery heart disease complicated with heart failure

作　　者：王磊[1] 王丹宁[1] 汤晔华[1] 张家友[1] 廖德宁[1] WANG Lei;WANG Dan-ning;TANG Ye-hua;ZHANG Jia-you;LIAO De-ning(Department of Cardiology,Shanghai Changzheng Hospital,the Second Military Medical University,Shanghai,200003,China)

机构地区：[1]第二军医大学上海长征医院心内科,上海200003

出　　处：《中国医学前沿杂志（电子版）》2019年第4期109-112,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探究老年冠心病合并心力衰竭患者医院感染的病原学特点及危险因素。方法回顾性分析2017年2月至2017年7月本院心内科收治的421例老年冠心病合并心力衰竭患者的临床资料,探讨老年冠心病合并心力衰竭患者医院感染的病原学特点及危险因素。结果 421例老年冠心病合并心力衰竭患者中,44例患者发生医院感染,其中呼吸系统、泌尿系统、消化系统、皮肤软组织感染率分别为56.82%、13.64%、18.18%、11.36%。44例发生医院感染者病原体培养共发现病原体92株,以铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌为主,分别占25.00%、16.30%、16.30%。铜绿假单胞菌和大肠埃希菌对左氧氟沙星、亚胺培南的敏感性较高,前者对头孢哌酮舒巴坦、头孢曲松、庆大霉素有较强耐药性,后者对氨苄西林、阿莫西林有较高耐药性;金黄色葡萄球菌对万古霉素、利奈唑胺、替考拉宁敏感性较高,对阿莫西林、环丙沙星具有较高的耐药性。年龄≥65岁、有慢性阻塞性肺疾病病史、有糖尿病病史、有吸烟史、纽约心脏协会心功能分级≥Ⅲ级、住院天数≥7 d、血浆白蛋白水平<30 g/L均为老年冠心病合并心力衰竭患者发生医院感染的独立危险因素(P_均<0.05)。结论熟悉老年冠心病合并心力衰竭患者医院感染的常见致病菌,明确危险因素,有利于临床及时采取有效的干预措施,以降低老年冠心病合并心力衰竭患者医院感染发生率。Objective To explore the etiological characteristics and risk factors of nosocomial infection in elderly patients with coronary artery heart disease complicated with heart failure.Method The clinical data of 421 elderly patients with coronary artery heart disease complicated with heart failure treated in our hospital from February 2017 to July 2017 were analyzed retrospectively,the etiological characteristics and risk factors of nosocomial infection in elderly patients with coronary artery heart disease complicated with heart failure were discussed.Result Of 421 elderly patients with coronary artery heart disease complicated with heart failure,44 patients had nosocomial infection.The infection rates of respiratory system,urinary system,digestive system,skin and soft tissue were 56.82%,13.64%,18.18% and 11.36% respectively.A total of 92 strains of pathogens were found in 44 elderly patients with coronary heart disease complicated with heart failure.Pseudomonas aeruginosa,Escherichia coli and Staphylococcus aureus were the main pathogens,accounting for 25.00%,16.30% and 16.30% respectively.Pseudomonas aeruginosa and Escherichia coli were more susceptible to Levofloxacin and Imipenem.The former was more resistant to Cefoperazone sulbactam,Ceftriaxone and Gentamicin,while the latter was more resistant to Ampicillin and Amoxicillin.Staphylococcus aureus was more susceptible to Vancomycin,Linezolid and Teicoplanin,and was more resistant to Amoxicillin and Ciprofloxacin.Age ≥ 65 years old,history of chronic obstructive pulmonary disease,history of diabetes mellitus,history of smoking,New York Heart Association cardiac function grade ≥Ⅲ grade,hospitalization days ≥ 7 days and plasma albumin level<30 g/L were all independent risk factors for nosocomial infection in elderly patients with coronary artery heart disease complicated with heart failure(Pall<0.05).Conclusion Familiar with the common pathogens of elderly patients with coronary artery heart disease complicated with heart failure,and clearly identify the ri

关 键 词：老年 冠心病 心力衰竭 医院感染 病原学特点 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R541.4[医药卫生—临床医学] R541.6