| 刘巧艳,王永兴,王 萍,白琸瑄,王 娟.多药耐药菌感染重症肺炎患者预后的危险因素分析[J].,2023,(10):1883-1888 |
| 多药耐药菌感染重症肺炎患者预后的危险因素分析 |
| Analysis of Prognostic Risk Factors in Patients with Severe Pneumonia Infected by Multidrug Resistant Bacteria |
| 投稿时间：2022-12-05 修订日期：2022-12-30 |
| DOI：10.13241/j.cnki.pmb.2023.10.014 |
| 中文关键词: 多药耐药菌感染 重症肺炎 预后 危险因素 |
| 英文关键词: Multi-drug resistant bacterial infection Severe pneumonia Prognosis Risk factors |
| 基金项目:陕西省重点研发计划项目（2022SF-517） |
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| 中文摘要: |
| 摘要 目的：探讨多药耐药菌感染重症肺炎患者预后的危险因素。方法：选取本院2019年5月至2022年5月收治的198例重症肺炎患者，根据患者在ICU住院期间是否死亡分为存活组（121例）和死亡组（77例）。对重症肺炎患者多药耐药菌感染情况，多药耐药G+耐药情况，多药耐药G-耐药情况进行分析，对影响多药耐药菌感染重症肺炎患者预后危险因素的单因素分析，将单因素分析中差异有统计学意义的变量进行多因素Logistic回归分析，筛选影响多药耐药菌感染重症肺炎患者预后的危险因素。结果：198例重症肺炎患者中，多药耐药菌感染患者60例，占比30.30 %，共分离出病原菌290株，其中多药耐药菌65株，占比22.41 %，其中占比比较高的有鲍曼不动杆菌（23.08 %）、铜绿假单胞菌（20.00 %）、金黄色葡萄球菌（20.00 %）、肠炎克雷伯菌（10.77 %）；重症肺炎患者多药耐药G+对青霉素、克林霉素、红霉素等具有较高的耐药性，而对万古霉素、替考拉宁、替加环素较为敏感；重症肺炎患者多重耐药G-对多种抗菌药物均表现出耐药性，其中对头孢他啶、头孢吡肟等具有较高的耐药性；单因素分析结果显示，死亡组患者中男性、年龄≥70岁、APACHEⅡ评分≥26分、有创通气的患者占比显著高于存活组，碳青霉烯类抗生素使用的患者占比显著低于存活组（均P<0.05），两组患者肺部基础疾病、脑血管疾病、高血压、联合使用其他抗生素的占比，以及两组患者机械通气时间比较无差异（均P>0.05）；纳入多因素非条件Logistic回归模型分析显示，男性、年龄≥70岁、APACHEⅡ评分≥26分、有创通气为多药耐药菌感染重症肺炎患者预后的危险因素（OR=1.568、1.203、2.812、1.674，均P<0.05），而碳青霉烯类抗生素使用是多药耐药菌感染重症肺炎患者预后的保护因素（OR=0.542，P<0.05）。结论：多药耐药菌感染重症肺炎患者的主要菌株为鲍曼不动杆菌，且男性、年龄≥70岁、APACHEⅡ评分≥26分、有创通气为多药耐药菌感染重症肺炎患者预后的危险因素，而碳青霉烯类抗生素使用是多药耐药菌感染重症肺炎患者预后的保护因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the prognostic risk factors of severe pneumonia infected by multidrug resistant bacteria. Methods: A total of 198 patients with severe pneumonia admitted to our hospital from May 2019 to May 2022 were selected and divided into survival group (121 cases) and death group (77 cases) according to whether the patients died during ICU stay. Multidrug-resistant bacteria infection, multidrug-resistant G+ drug resistance and multidrug-resistant G- drug resistance in severe pneumonia patients were analyzed. Univariate analysis was conducted on the prognostic risk factors of patients with severe pneumonia infected with multidrug-resistant bacteria. Multivariate Logistic regression analysis was performed on variables with statistically significant differences in the univariate analysis. To screen the risk factors affecting the prognosis of patients with severe pneumonia infected by multi-drug resistant bacteria. Results: Among the 198 patients with severe pneumonia, 60 were infected with multidrug-resistant bacteria, accounting for 30.30 %. A total of 290 pathogens were isolated, among which 65 were multi-drug-resistant bacteria, accounting for 22.41 %, which were A. baumannii (23.08 %), Pseudomonas aeruginosa (20.00 %), Staphylococcus aureus (20.00 %) and Klebsiella enteritidis (10.77 %). Multi-drug resistant G+ in severe pneumonia has high resistance to penicillin, clindamycin and erythromycin, but was sensitive to vancomycin, teicorranin, teicycline and tigecycline; multi-drug resistant G- showed resistance to various antimicrobial drugs, with high resistance to ceftazidime and cefepime. The results of univariate analysis showed that the proportion of patients in the death group who were male, ≥70 years old, had an APACHE II score ≥26, and had invasive ventilation was significantly higher than that in the survival group, and the proportion of patients on carbapenem antibiotics was significantly lower than that in the survival group, and the proportions of patients with underlying lung disease, cerebrovascular disease, hypertension, and combination of other antibiotics in the two groups, as well as the proportion of patients in the two groups, there was no difference in the comparison of the duration of mechanical ventilation (both P>0.05). Inclusion of multivariate non-conditional Logistic regression model analysis showed that men, age 70, APACHEⅡ score 26, and invasive ventilation were risk factors in patients with severe pneumonia (OR=1.568,1.203,2.812,1.674, all P<0.05), and carbapenem use was a protective factor in the outcome of patients with severe pneumonia (OR=0.542, P<0.05). Conclusion: The main strains of patients with MDR infection with severe pneumonia were Acinetobacter baumannii, and men, age 70 years, APACHEⅡ score of 26, and invasive ventilation were risk factors for patients with MDR infection severe pneumonia, while the use of carbapenems was a protective factor in patients with severe pneumonia infection with MDR. |
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