革兰阴性菌社区获得性肺炎临床特点及预后危险因素  

作　　者：沈枫峰 肖兰娟 凌欢 邓友杰 

机构地区：[1]湖州学院附属南太湖医院,313000 [2]陆军第72集团军医院,313000

出　　处：《浙江临床医学》2025年第2期250-252,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨革兰阴性菌社区获得性肺炎(CAP)患者临床特点及其预后危险因素。方法选择2019年6月至2023年6月湖州学院附属南太湖医院和2016年1月至2022年12月陆军第72集团军医院收治的361例革兰阴性菌CAP患者作为研究对象,收集临床资料和病原菌分布情况,并采用多因素Logistic回归分析预后危险因素。结果在361例患者中,痰培养检出386株革兰阴性菌,其中以肺炎克雷伯菌、铜绿假单胞菌为主,检出率分别为40.41%、27.72%。单因素分析显示,年龄、BMI指数、糖尿病、脑卒中、肺部MDR-GNB感染、入住ICU、CONUT评分、CURB-65评分及CRP与预后显著相关(P<0.05)。多因素Logistic回归分析显示,脑卒中(OR=3.247)、肺部MDR-GNB感染(OR=3.610)、CONUT评分(OR=1.408)、CURB-65评分(OR=2.487)、C-反应蛋白(CRP)(OR=1.029)是影响患者预后的独立危险因素(P<0.05)。结论革兰阴性菌CAP患者的主要病原菌为肺炎克雷伯菌和铜绿假单胞菌。脑卒中、肺部MDR-GNB感染、高CONUT评分、高CURB-65评分以及CRP升高均可增加患者死亡风险。Objective To investigate the clinical characteristics and prognostic risk factors of patients with community-acquired pneumonia(CAP)caused by Gram-negative bacteria.Methods A total of 361 patients with Gram-negative bacterial CAP admitted to Nan Taihu Hospital affiliated with Huzhou University from June 2019 to June 2023,and to the 72nd Group Army Hospital of the PLA from January 2016 to December 2022,were selected as the subjects.Clinical data and pathogen distribution were collected,and multiple logistic regression analysis was used to analyze prognostic risk factors.Results Among the 361 patients,386 strains of Gram-negative bacteria were identified via sputum culture,with Klebsiella pneumoniae and Pseudomonas aeruginosa being the predominant pathogens,accounting for 40.41%and 27.72%of the isolates,respectively.Univariate analysis showed that age,body mass index(BMI),diabetes,stroke,pulmonary infection with multidrug-resistant Gram-negative bacteria(MDR-GNB),ICU admission,CONUT score,CURB-65 score,and C-reactive protein(CRP)were statistically associated with prognosis(P<0.05).Multivariate logistic regression analysis revealed that stroke(OR=3.247),pulmonary MDR-GNB infection(OR=3.610),CONUT score(OR=1.408),CURB-65 score(OR=2.487),and CRP(OR=1.029)were independent risk factors affecting patient prognosis(P<0.05).Conclusion Gram-negative bacteria CAP patients are mainly infected with klebsiella pneumoniae and pseudomonas aeruginosa.Stroke,pulmonary MDR-GNB infection,high CONUT score,high CURB-65 score,and elevated CRP levels can all increase the risk of patient mortality.

关 键 词：革兰阴性菌 社区获得性肺炎 病原菌 预后 危险因素 

分 类 号：R56[医药卫生—呼吸系统]