医院获得性铜绿假单胞菌肺炎危险因素分析  

Risk factorsanalysis for hospital-acquired pneumonia caused by Pseudomonas aeruginosa

作　　者：孙康 李王平 潘蕾 金发光 Sun Kang;Li Wangping;Pan Lei;Jin Faguang(Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi′an 710032, China)

机构地区：[1]空军军医大学唐都医院呼吸与危重症医学科,西安710032

出　　处：《中华肺部疾病杂志（电子版）》2022年第2期166-170,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：陕西省科技计划项目(2020SF-112)。

摘　　要：目的分析医院获得性铜绿假单胞菌肺炎的危险因素,指导初始经验性抗菌治疗。方法选择空军军医大学第二附属医院2019年1月至2019年6月的所有医院获得性革兰阴性杆菌肺炎(GNB-HAP)患者374例,根据细菌培养结果分为医院获得性铜绿假单胞菌肺炎组(PA-HAP)81例,医院获得性非铜绿假单胞菌肺炎组(non-PA-HAP)293例,在获得呼吸道合格标本当天对变量进行评估,将单因素分析P<0.05的自变量纳入多因素Logistic回归分析,找到因变量的危险因素。结果在单因素分析中,与PA-HAP相关的潜在危险因素包括呼吸道标本收集日期距离住院日的天数、未入住ICU、未接受脑科手术、无颅腔引流管、无昏迷、无误吸风险、无脑梗塞、无脑出血、胸科手术、留置胸腔引流管、布地奈德吸入、肿瘤、脾切除术。多因素Logistic回归分析确定PA-HAP的独立危险因素:胸科手术[adjusted odds ratio(aOR)2.462,95%CI 1.237~4.900]、无昏迷(2.516,1.368~4.627)、布地奈德吸入(1.883,1.049~3.393)、脾切除术(5.039,1.051~24.154)。结论住院期间伴有胸科手术、吸入布地奈德、脾切除术而无昏迷的GNB-HAP患者应警惕铜绿假单胞菌感染。Objective To analyze the risk factors of hospital-acquired pneumonia caused by Pseudomonas aeruginosa,so as to guide the initial empirical antimicrobial treatment.Methods All of 374 patients with hospital acquired pneumonia caused by Gram-negative bacilli(GNB-HAP)in our hospital during January 2019 to June 2019 were included in the study.Patients were divided into hospital acquired Pseudomonas aeruginosa pneumonia group(81 cases)and hospital acquired non-Pseudomonas aeruginosa pneumonia group(293 cases)according to whether the bacterial culture results were Pseudomonas aeruginosa.The variables were assessed on the day when qualified respiratory specimens were obtained.Variables with a P<0.05 in univariable analysis were then included in the multivariablelogistic regression analysis to find the independent risk factor of PA-HAP.Results The potential risk factors associated with PA-HAP in the univariate analysiswere Days from the specimens collection date to the date in hospital;no admission to ICU,no Cerebral surgery,no cranial drainage,no coma,no risk of aspiration,no cerebral infarction,no cerebral hemorrhage,thoracic surgery;thoracic drainage;budesonide inhalation;tumor;splenectomy.Theindependent risk factors of PA-HAP determined by multivariate logistic regression analysis included thoracic surgery[adjusted odds ratio(aOR)2.462,95%CI 1.237~4.900];no coma(2.516,1.368~4.627);budesonide inhalation(1.883,1.049~3.393);splenectomy(5.039,1.051~24.15).Conclusions Pseudomonas aeruginosa infection should be on alert in patients with GNB-HAP who have thoracic surgery,inhaled budesonide,splenectomy and no coma during hospitalization.

关 键 词：医院获得性肺炎 革兰阴性杆菌 铜绿假单胞菌 危险因素 经验性抗菌治疗 

分 类 号：R563[医药卫生—呼吸系统]