天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (1): 93-96.doi: 10.3969/j.issn.0253-9896.2015.01.025

• 流行病学调查 • 上一篇    下一篇

唐山地区成人社区获得性肺炎感染革兰阴性菌的#br# 危险因素分析#br#

刘向欣 1， 刘运秋 2△， 耿贺梅 1， 张景义 3， 蒋永会 4， 蒲景环 5， 景云天 6#br#   

  1. 1 河北联合大学附属开滦总医院感染管理科(邮编 063000)； 2河北联合大学附属开滦总医院呼吸内科； 3 河北联合大学附属开滦
    总医院内分泌科；4唐钢集团有限责任公司医院神经内科；5 河北联合大学附属开滦总医院医教部；6中国医科大学临床医学系
  • 收稿日期:2014-03-07 修回日期:2014-09-24 出版日期:2015-01-15 发布日期:2015-01-30
  • 通讯作者: 刘运秋E-mail:tshxnk@163.com E-mail:2582686331@qq.com
  • 作者简介:刘向欣（1978）， 女， 硕士， 主要从事感染管理方面研究
  • 基金资助:
    河北省卫生厅医学科学研究指导性课题（20130608）

Analysis of risk factors for adult community-acquired pneumonia caused by Gram negative bacilli in Tangshan

LIU Xiangxin1, LIU Yunqiu2△, GENG Hemei1, ZHANG Jingyi3, JIANG Yonghui4， PU Jinghuan5, JING Yuntian6#br# #br#   

  1. 1 Department of Infection Management of the Affiliated Kailuan General Hospital of Hebei United University, Tangshan, He Bei 063000, China; 2 Department of Respiratory of the Affiliated Kailuan General Hospital of Hebei United University; 3 Department of Endocrinology of the Affiliated Kailuan General Hospital of Hebei United University; 4 Department of Neurol? ogy of Tangshan Iron and Steel Group Co., Ltd. Hospital; 5 Department of Psychiatry of the Affiliated Kailuan General Hospital of Hebei United University; 6 Department of Clinical Medicine of China Medical University
  • Received:2014-03-07 Revised:2014-09-24 Published:2015-01-15 Online:2015-01-30
  • Contact: E-mail:tshxnk@163.com E-mail:2582686331@qq.com

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摘要： 目的 分析唐山地区成人社区获得性肺炎（CAP）患者感染革兰阴性菌的危险因素， 为早期识别革兰阴性菌 CAP 和合理用药提供借鉴。 方法 2011 年 10 月—2012 年 9 月期间， 选取唐山市行政区域内 6 所医院呼吸内科确诊为 CAP 的成人住院患者 530 例， 收集患者一般资料、体格检查、辅助检查和病原学资料， 依据以上资料计算患者预后研究小组评分（PORT）； 采集患者痰标本进行致病菌检测。 采用单因素 Logistic 回归和多因素 Logistic 回归分析 CAP 患者感染革兰阴性菌的危险因素。 结果 530 例 CAP 患者中， 172 例（32.45%）患者检测出细菌 195 株， 其中革兰阴性菌 154 株（78.97%）， 革兰阳性菌 41 株（21.03%）。 单因素 Logistic 回归分析结果显示， 年龄≥65 岁、入院前应用抗生素、合并基础疾病、合并脑血管疾病、营养不良、白细胞异常、中性粒细胞＜ 1×109/L、PORT≥Ⅲ 级、总胆红素＞ 17.1 μmol/L 和血尿素氮＞ 7.1 mmol/L 为 CAP 患者感染革兰阴性菌的可能危险因素。 多因素 Logistic 回归分析结果显示， 入院前应用抗生素（OR=2.327， 95%CI 为 1.453～ 3.725）， 白细胞异常（OR=2.904， 95%CI 为 1.879～ 4.490）， PORT≥Ⅲ 级（OR=3.839， 95%CI 为 2.427～ 6.071）， 血尿素氮＞ 7.1 mmol/L（OR=4.133， 95%CI 为 2.585～ 6.606）为革兰阴性菌 CAP 的独立危险因素。 结论 入院前应用抗生素、白细胞异常、PORT≥Ⅲ 级、血尿素氮＞ 7.1 mmol/L 的 CAP 患者易感染革兰阴性菌， 临床经验性抗感染治疗应考虑以上危险因素。

关键词: 肺炎, 革兰阴性菌, 机会致病菌感染, 危险因素, 成年人, 社区获得性肺炎, 唐山

Abstract: Abstract： Objective To analyze the clinical characteristics and risk factors for adult community-acquired pneumonia (CAP) caused by Gram-negative bacilli in Tangshan, and provide reference for the early identification of Gram-negative bac⁃ teria CAP and the clinical use of antibiotics. Methods Data of retrospective general information, physical examination, aux⁃ iliary examination and pathogen were collected in patients with CAP in respiratory department from 6 hospitals in Tangshan between October 2011 to September 2012. According to the above data, the prognosis of patients with the team score (PORT) was calculated. The sputum samples were isolated for pathogen identification. Univariate logistic regression analysis and multivariate logistic regression analysis were performed for risk factors of Gram-negative bacilli. Results A total of 195 strains were isolated from 172 (32.45%) patients in 530 patients with CAP. There were 154 strains of Gram-negative ba⁃ cilli (78.97%) and 41 strains of Gram-positive bacteria (21.03%) in 195 bacterial strains. Univariate logistic regression anal⁃ ysis showed the possible risk factors of Gram-negative bacilli in patients with CAP including age≥65 years old, using antibi⁃ otics before hospitalization, basic diseases, cerebrovascular disease, malnutrion, white blood cell abnormal, neutrophilcount＜ 1 ×109/L, PORT classification≥Ⅲ, total bilirubin＞ 17.1 μmol/L and blood urea nitrogen＞ 7.1 mmol/L. Multivariate logistic regression analysis showed the independent risk factors of Gram-negative bacilli in patients with CAP including us⁃ ing antibiotics before hospitalization (OR = 2.327, 95% CI 1.453 -3.725), white blood cell abnormal (OR = 2.904, 95% CI 1.879- 4.490), PORT classification≥Ⅲ (OR = 3.839, 95% CI 2.427 -6.071), and blood urea nitrogen elevated (OR = 4.133, 95% CI 2.585 -6.606). Conclusion Clinical empirical anti-infection treatment should consider the risk factors including using antibiotics before hospitalization, white blood cell abnormal, PORT classification≥Ⅲ and blood urea nitrogen＞ 7.1 mmol/L in patients with susceptible to Gram-negative bacteria infection.

Key words: pneumonia, Gram- negative bacteria, opportunistic infections, risk factors, adult, community acquired pneumonia, Tangshan