CHD合并心衰患者肺部感染的发生率、病原菌分布特征及影响因素分析  

The incidence of pulmonary infection in CHD patients with heart failure,pathogenic bacteria distribution characteristics and influencing factors analysis

作　　者：田现伟 张学平 李医博 刘志强 TIAN Xianwei;ZHANG Xueping;LI Yibo;LIU Zhiqiang(Xinxiang Central Hospital,Xinriang Medica College,the fourth Clinical College,Xiniang,Henan 453000,China)

机构地区：[1]新乡市中心医院,新乡医学院第四临床学院心血管内四科,河南新乡453000

出　　处：《中国病原生物学杂志》2025年第5期656-660,共5页Journal of Pathogen Biology

摘　　要：目的探究冠心病(CHD)合并心衰患者肺部感染的发生率、病原菌分布特征及影响因素。方法以2022年6月-2024年6月本院收治的106例CHD合并心衰患者作为研究对象,对所有患者行肺部感染的检测,将确诊肺部感染患者行细菌鉴定和药敏试验。单因素分析感染组和未感染组临床特征的差异;Logistic回归分析CHD合并心衰患者肺部感染发生的影响因素;CHD合并心衰患者肺部感染患者病原菌分布特点;分析CHD合并心衰肺部感染患者常见革兰阳性和阴性菌耐药情况。结果本研究纳入的106例患者中发生感染患者共计35例并纳入感染组(n=35),将剩余患者纳入未感染组(n=71);感染组年龄>60岁、心功能分级>Ⅱ级、侵入性操作(是)和住院时间>10 d占比显著高于未感染组(均P<0.05);Logistic回归模型分析结果显示年龄、心功能分级、侵入性操作和住院时间是CHD合并心衰患者发生肺部感染的危险因素(P<0.05);35例感染患者共检出86例病原菌,其中占比从高至低分别是革兰阴性菌、革兰阳性菌和真菌;头孢哌酮耐药上,肺炎克雷伯菌高达96.15%,铜绿假单胞菌16.67%,鲍曼不动杆菌无耐药;头孢呋辛耐药率在三者中依次为53.85%、83.33%、91.67%。阿莫西林、氨苄西林致鲍曼不动杆菌100%耐药,各菌对不同抗生素耐药表现差异显著;11株金黄色葡萄球菌对前两者耐药率高达90%以上,对红霉素耐药率为63.64%;7株肺炎链球菌对这三种药耐药率在28.57%~57.14%;5株表皮葡萄球菌对应耐药率处于60%~80%。而万古霉素、利奈唑胺耐药率低,均在20%以下。结论本研究对106例CHD合并心衰患者研究发现35例发生肺部感染。年龄>60岁、心功能分级>Ⅱ级、侵入性操作及住院时间>10 d是感染危险因素。共检出86株病原菌,革兰阴性菌居多。各菌种对抗生素耐药性差异大,为防控CHD合并心衰患者肺部感染、精准用药提供关键依据。Objective To investigate the incidence,pathogenic bacteria distribution and influencing factors of pulmonary infection in patients with coronary heart disease(CHD)complicated with heart failure.Methods A total of 106 patients with CHD combined with heart failure admitted to our hospital from June 2022 to June 2024 were taken as the study objects.All patients were tested for pulmonary infection,and bacteria identification and drug susceptibility tests were performed for those diagnosed with pulmonary infection.The difference of clinical features between infected group and uninfected group was analyzed by single factor analysis.Logistic regression analysis was performed to analyze the influencing factors of pulmonary infection in CHD patients with heart failure.Distribution characteristics of pathogenic bacteria in pulmonary infection of CHD patients with heart failure;The common gram-positive and gram-negative bacterial resistance in CHD patients with heart failure pulmonary infection was analyzed.Results Among the 106 patients included in this study,a total of 35 infected patients were included in the infected group(n=35),and the remaining patients were included in the uninfected group(n=71).The proportion of age>60 years old,cardiac function grade>Ⅱ,invasive operation(yes)and hospital stay>10 d in infected group was significantly higher than that in uninfected group(all P<0.05).Logistic regression model analysis showed that age,cardiac function grade,invasive procedure and length of stay were risk factors for pulmonary infection in CHD patients with heart failure(P<0.05).A total of 86 pathogens were detected in 35 infected patients,among which the proportion of gram-negative bacteria,gram-positive bacteria and fungi were respectively from high to low.Cefoperazone resistance was 96.15%in Klebsiella pneumoniae,16.67% in Pseudomonas aeruginosa,and no resistance in Acinetobacter baumannii.The drug resistance rate of cefuroxime was 53.85%,83.33% and 91.67%,respectively.Amoxicillin and ampicillin caused 100% resista

关 键 词：冠心病 心力衰竭 肺部感染 病原菌 危险因素 

分 类 号：R54[医药卫生—心血管疾病] R563.1[医药卫生—内科学]