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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2022年02期

页码:

166-170

栏目:

论著

出版日期:

2022-04-20

文章信息/Info

Title:

Risk factorsanalysis for hospital-acquired pneumonia caused by Pseudomonas aeruginosa

作者:

孙 康; 李王平; 潘 蕾; 金发光

710032 西安,空军军医大学唐都医院呼吸与危重症医学科

Author(s):

Sun Kang;  Li Wangping;  Pan Lei;  Jin Faguang.

Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi'an 710032, China

关键词:

医院获得性肺炎;  革兰阴性杆菌;  铜绿假单胞菌;  危险因素;  经验性抗菌治疗

Keywords:

Hospital acquired pneumonia;  Gram-negative bacilli;  Pseudomonas aeruginosa;  Risk factors analysis;  Empirical antibiotic therapy

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2022.02.006

摘要:

目的 分析医院获得性铜绿假单胞菌肺炎的危险因素,指导初始经验性抗菌治疗。方法 选择空军军医大学第二附属医院2019年1月至2019年6月的所有医院获得性革兰阴性杆菌肺炎(GNB-HAP)患者374例,根据细菌培养结果分为医院获得性铜绿假单胞菌肺炎组(PA-HAP)81例,医院获得性非铜绿假单胞菌肺炎组(non-PA-HAP)293例,在获得呼吸道合格标本当天对变量进行评估,将单因素分析P<0.05的自变量纳入多因素Logistic回归分析,找到因变量的危险因素。结果 在单因素分析中,与PA-HAP相关的潜在危险因素包括呼吸道标本收集日期距离住院日的天数、未入住ICU、未接受脑科手术、无颅腔引流管、无昏迷、无误吸风险、无脑梗塞、无脑出血、胸科手术、留置胸腔引流管、布地奈德吸入、肿瘤、脾切除术。多因素Logistic回归分析确定PA-HAP的独立危险因素:胸科手术[adjusted odds ratio(aOR)2.462, 95%CI 1.237～4.900]、无昏迷(2.516, 1.368～4.627)、布地奈德吸入(1.883, 1.049～3.393)、脾切除术(5.039, 1.051～24.154)。结论 住院期间伴有胸科手术、吸入布地奈德、脾切除术而无昏迷的GNB-HAP患者应警惕铜绿假单胞菌感染。

Abstract:

Objective To analyze the risk factors of hospital-acquired pneumonia caused by Pseudomonas aeruginosa, so as to guide the initial empirical antimicrobial treatment. Methods All of 374 patients with hospital acquired pneumonia caused by Gram-negative bacilli(GNB-HAP)in our hospital during January 2019 to June 2019 were included in the study. Patients were divided into hospital acquired Pseudomonas aeruginosa pneumonia group(81 cases)and hospital acquired non-Pseudomonas aeruginosa pneumonia group(293 cases)according to whether the bacterial culture results were Pseudomonas aeruginosa. The variables were assessed on the day when qualified respiratory specimens were obtained. Variables with a P<0.05 in univariable analysis were then included in the multivariablelogistic regression analysis to find the independent risk factor of PA-HAP. Results The potential risk factors associated with PA-HAP in the univariate analysiswere Days from the specimens collection date to the date in hospital; no admission to ICU, no Cerebral surgery, no cranial drainage, no coma, no risk of aspiration, no cerebral infarction, no cerebral hemorrhage, thoracic surgery; thoracic drainage; budesonide inhalation; tumor; splenectomy. Theindependent risk factors of PA-HAP determined by multivariate logistic regression analysis included thoracic surgery [adjusted odds ratio(aOR)2.462, 95%CI 1.237～4.900]; no coma(2.516, 1.368～4.627); budesonide inhalation(1.883, 1.049～3.393); splenectomy(5.039, 1.051～24.15). Conclusions Pseudomonas aeruginosa infection should be on alert in patients with GNB-HAP who have thoracic surgery, inhaled budesonide, splenectomy and no coma during hospitalization.

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备注/Memo

备注/Memo:

基金项目: 陕西省科技计划项目(2020SF-112) 通信作者: 潘 蕾, Email: panlei@fmmu.edu.cn

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更新日期/Last Update: 2022-04-20