医院获得性肺炎老年患者痰液细菌培养与药敏分析及病情发展影响因素  

Sputum Bacterial Culture and Drug Sensitivity Analysis of Elderly Patients with Hospital Acquired Pneumonia and Factors Affecting Disease Progression

作　　者：程易[1] 黄锦宏[1] 由振华[1] 周秀芬 陈虹 CHENG Yi;HUANG Jinhong;YOU Zhenhua;ZHOU Xiufen;CHEN Hong(Department of Respiratory and Critical Care Medicine,Changshu Second People´s Hospital,Changshu,Jiangsu Province,215501 China)

机构地区：[1]常熟市第二人民医院呼吸与危重症医学科,江苏常熟215501

出　　处：《系统医学》2023年第5期55-59,共5页Systems Medicine

摘　　要：目的对医院获得性肺炎(hospital acquired pneumonia,HAP)老年患者痰液细菌培养与药敏结果及病情发展影响因素进行分析和探讨。方法回顾性分析2019年10月—2021年11月常熟市第二人民医院各个科室收治的110例确诊为HAP的老年患者的临床资料。采集其深部痰液开展细菌培养和药敏实验,统计其病原菌检出情况和菌药物的耐药性。依据患者病情发展情况,将110例HAP老年患者分为重症肺炎组(n=27)和非重症肺炎组(n=83),通过单因素和多因素Logistic回归分析方法分析影响HAP老年患者重症肺炎的因素。结果110例老年HAP患者中,共有91例患者的痰液标本检测结果为阳性,阳性率为82.73%,共培养出116株细菌。其中革兰阴性菌、革兰阳性菌、真菌分别为67、38、11株,依次占比57.76%、32.76%、9.48%;在革兰阴性菌中,肺炎克雷伯菌、铜绿假单胞菌对美罗培南的耐药率最低,依次为0.00%、25.00%;阴沟肠杆菌对美罗培南、庆大霉素、阿米卡星的耐药率最低,均为45.45%;鲍曼不动杆菌、大肠埃希菌则对亚胺培南耐药率最低(0.00%);在革兰阳性菌中,粪肠杆菌、溶血葡萄球菌、金黄色葡萄球菌均对万古霉素和替考拉宁的耐药率最低(0.00%)。多因素Logistic回归分析结果显示,合并COPD(OR=2.333,P=0.009)、合并糖尿病(OR=4.646,P=0.001)、合并肿瘤(OR=1.636,P<0.001)是影响HAP老年患者重症肺炎的独立影响因素。结论HAP老年患者的病原菌检测中,革兰阴性菌的占比最高,革兰阴性菌和革兰阳性菌对美罗培南和万古霉素、替考拉宁的耐药率均较低。导致HAP老年患者重症肺炎的独立影响因素包括合并COPD、合并糖尿病、合并肿瘤,应对相关危险因素予以有效控制,以降低HAP老年患者发生重症肺炎的风险。Objective To analyze and discuss the sputum bacterial culture and drug sensitivity results and factors influencing disease progression in elderly patients with hospital acquired pneumonia(HAP).Methods The clinical data of 110 elderly patients diagnosed with HAP admitted to various departments of Changshu Second People´s Hospital from October 2019 to November 2021 were retrospectively analyzed.The deep sputum was collected for bacterial culture and drug sensitivity test,and the detection of pathogenic bacteria and drug resistance were counted.According to the development of the disease,110 elderly patients with HAP were divided into severe pneumonia group(n=27)and non-severe pneumonia group(n=83).Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of severe pneumonia in elderly patients with HAP.Results Among 110 elderly patients with HAP,the sputum samples of 91 patients were positive,with a positive rate of 82.73%,and 116 strains of bacteria were cultured.There were 67 strains of gram-negative bacteria,38 strains of gram-positive bacteria and 11 strains of fungi,accounting for 57.76%,32.76%and 9.48%,respectively.Among gram-negative bacteria,the resistance rates of klebsi-ella pneumoniae and pseudomonas aeruginosa to meropenem were the lowest,which were 0.00%and 25.00%respec-tively.The resistance rate of enterobacter cloacae to meropenem,gentamicin and amikacin was the lowest(45.45%).Acinetobacter baumannii and escherichia coli had the lowest resistance rate to imipenem(0.00%).Among gram positive bacteria,enterobacter faecalis,staphylococcus haemolyticus and staphylococcus aureus all had the lowest resistance rate to vancomycin and teicolanin(0.00%).Multivariate Logistic regression analysis showed that COPD com-bined(OR=2.333,P=0.009),diabetes combined(OR=4.646,P=0.001)and tumor combined(OR=1.636,P<0.001)were independent factors affecting HAP severe pneumonia in elderly patients.Conclusion In elderly patients with HAP,the proportion of Gram-negative bacteria was

关 键 词：医院获得性肺炎 老年患者 药敏试验 病原菌分布 影响因素 

分 类 号：R4[医药卫生—临床医学]