慢性阻塞性肺病急性加重患者呼吸道多重耐药菌感染危险因素分析
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摘要
目的分析慢性阻塞性肺疾病急性加重(AECOPD)患者呼吸道多重耐药菌感染的危险因素,为防控COPD提供依据。方法选取2015年1月-2017年3月医院收治的AECOPD合并呼吸道细菌感染患者78例作为研究对象,分析多重耐药菌感染率,并采用单因素及多因素logistic回归方法对AECOPD合并呼吸道多重耐药菌感染的危险因素进行分析。结果 AECOPD患者肺部多重耐药菌感染率为14.10%。单因素分析结果显示,呼吸衰竭、既往一年因COPD入院次数、呼吸疾病史,对AECOPD合并呼吸道多重耐药菌感染的影响有统计学意义(P<0.05);多因素logistic回归分析结果显示,呼吸衰竭、既往一年因COPD入院次数是导致AECOPD合并呼吸道多重耐药菌感染的独立危险因素(P<0.05)。结论 AECOPD合并肺部感染中,多重耐药菌感染比例较高。呼吸衰竭、既往一年因COPD入院次数,是AECOPD合并多重耐药菌感染的独立危险因素,及早控制这些危险因素可以降低AECOPD患者合并多重耐药菌感染。
Objective To explore the risk factors for lower respiratory tract infections caused by multidrug-resistant bacterial(MDRB) in AECOPD patients and to provide scientific evidence for prevention and control of COPD. Methods 78 AECOPD patients with lower respiratory tract infection were selected from January 2015 to March 2017,the incidence of MDRB infection was observed,and then the univariate analysis and the multivariate logistic regression analysis were performed to analyze the risk factors for MDRB infection in the AECOPD patients. Results The incidence of MDRB infection was 14. 10%. Univariate analysis showed that the influences of respiratory disease history,number of hospitalizations in the past year,and respiratory failure on pulmonary MDRB infection in patients with AECOPD were statistically significant( P < 0. 05). The multivariate logistic regression analysis indicated that number of hospitalizations in the past year and respiratory failure were the independent risk factors for pulmonary MDRB infection in patients with AECOPD( P < 0. 05). Conclusion In AECOPD patients combined with pulmonary infection,the detection rate of multidrug-resistant bacteria is large. The number of hospitalizations in the past year and respiratory failure are the independent risk factors for pulmonary MDRB infection in patients with AECOPD.Early prevention and control of these risk factors can reduce MDRB infection in AECOPD patients.
Objective To explore the risk factors for lower respiratory tract infections caused by multidrug-resistant bacterial(MDRB) in AECOPD patients and to provide scientific evidence for prevention and control of COPD. Methods 78 AECOPD patients with lower respiratory tract infection were selected from January 2015 to March 2017,the incidence of MDRB infection was observed,and then the univariate analysis and the multivariate logistic regression analysis were performed to analyze the risk factors for MDRB infection in the AECOPD patients. Results The incidence of MDRB infection was 14. 10%. Univariate analysis showed that the influences of respiratory disease history,number of hospitalizations in the past year,and respiratory failure on pulmonary MDRB infection in patients with AECOPD were statistically significant( P < 0. 05). The multivariate logistic regression analysis indicated that number of hospitalizations in the past year and respiratory failure were the independent risk factors for pulmonary MDRB infection in patients with AECOPD( P < 0. 05). Conclusion In AECOPD patients combined with pulmonary infection,the detection rate of multidrug-resistant bacteria is large. The number of hospitalizations in the past year and respiratory failure are the independent risk factors for pulmonary MDRB infection in patients with AECOPD.Early prevention and control of these risk factors can reduce MDRB infection in AECOPD patients.
引文
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[13] 孙莉,薛永朝,单晓萍,等.重症监护病房中呼吸道感染菌监测及耐药感染因素的分析[J].临床肺科杂志,2013,18(6):1037-1039.
[14] 吴文汉,孙爱华,袁满春,等.重度慢性阻塞性肺疾病患者多药耐药革兰阴性菌下呼吸道感染的危险因素分析[J].中华医院感染学杂志,2016,26(20):4635-4637.
[15] 梁汝,陈韫.老年慢阻肺患者多重耐药菌感染相关危险因素分析[J].华夏医学,2017,30(5):55-58.
[2] 陈晓,何和章,林容,等.慢性阻塞性肺疾病急性加重期住院患者病毒感染危险因素分析[J].中华医院感染学杂志,2016,26(19):4452-4454.
[3] SETHI S,MURPHY T F.Infection in the pathogenesis and course of chronic obstructive pulmonary disease[J].N Engl J Med,2008,359(22):2355-2365.
[4] NSEIR S,DI POMPEO C,CAVESTRI B,et al.Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease:prevalence,risk factors,and outcome[J].Crit Care Med,2006,34(12):2959-2966.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[S].中华结核和呼吸杂志,2013,36(4):255-264.
[6] 中华人民共和国卫生部.医院感染诊断标准(试行)[S].中华医学杂志,2001,81(5):314-320.
[7] 刘延一,杨俊华,叶丹,等.慢性阻塞性肺病急性加重患者预后影响因素分析[J].成都医学院学报,2018,13(1):81-84,88.
[8] 何权瀛.中国慢性阻塞性肺疾病患者现状研究主要结果[J].中国医学论坛报,2007,9(33):5.
[9] 聂晓红,朱鹏飞,张剑,等.老年慢性阻塞性肺疾病急性加重合并肺炎病原菌及多重耐药菌分析[J].华西医学,2017,32(11):1708-1712.
[10] 贾育红,袁天柱,刘滨.重症监护室医院下呼吸道感染常见非发酵菌的耐药性与危险因素[J].中国感染控制杂志,2012,11(2):104-108.
[11] 田桂珍,高鸿敏,李小芳,等.呼吸内科病房多重耐药菌感染患者临床分析[J].中国临床药理学杂志,2013,29(6):437-439.
[12] 莫焕桐,陈小丽,陈伟忠.院内下呼吸道多重耐药菌感染的特点及危险因素[J].广东医学,2014,35(16):2581-2583.
[13] 孙莉,薛永朝,单晓萍,等.重症监护病房中呼吸道感染菌监测及耐药感染因素的分析[J].临床肺科杂志,2013,18(6):1037-1039.
[14] 吴文汉,孙爱华,袁满春,等.重度慢性阻塞性肺疾病患者多药耐药革兰阴性菌下呼吸道感染的危险因素分析[J].中华医院感染学杂志,2016,26(20):4635-4637.
[15] 梁汝,陈韫.老年慢阻肺患者多重耐药菌感染相关危险因素分析[J].华夏医学,2017,30(5):55-58.
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