老年肺结核患者呼吸机相关性肺炎的病原菌特点与危险因素分析

发布时间：2018-04-15 09:25

本文选题：肺结核 + 危险因素　；参考：《中华医院感染学杂志》2015年13期

【摘要】：目的探讨老年肺结核患者呼吸机相关性肺炎(VAP)的病原菌特点及危险因素,为临床预防VAP提供参考。方法回顾性分析2007年6月-2014年2月医院收治的176例接受机械通气肺结核患者临床资料,对老年肺结核患者并发VAP的病原菌分布、耐药性特点及危险因素进行总结分析,采用单因素及多因素logistic回归方法进行统计分析。结果 176例接受机械通气肺结核患者发生VAP 75例,发生率为42.6%,筛选出年龄70岁、病程5年、病灶范围4个肺野、空洞数量4个、结核菌素试验阴性、复治患者、有合并症、机械通气时间7d与老年肺结核患者发生VAP呈正相关;发生VAP老年肺结核患者分离出120株病原菌,其中革兰阴性菌占71.7%,真菌占18.3%,革兰阳性菌占10.0%;主要革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南及氨曲南等耐药率均≥50.0%。结论老年肺结核患者发生VAP的独立危险因素多,VAP主要的病原菌以革兰阴性菌及真菌为主,混合感染发生率高,且耐药性较高。
[Abstract]:Objective to investigate the pathogenic characteristics and risk factors of ventilator-associated pneumonia (VAP) in elderly patients with pulmonary tuberculosis, and to provide reference for clinical prevention of VAP.Methods the clinical data of 176 pulmonary tuberculosis patients with mechanical ventilation from June 2007 to February 2014 were retrospectively analyzed. The distribution of pathogens, drug resistance and risk factors in elderly patients with pulmonary tuberculosis complicated with VAP were summarized and analyzed.Single factor and multi-factor logistic regression were used for statistical analysis.Results there were 75 cases of pulmonary tuberculosis with mechanical ventilation, the incidence rate was 42.6 years, the age was 70 years, the course of disease was 5 years, the focus was 4 lung fields, the number of cavities was 4, the tuberculin test was negative, the patients with recurrent treatment had complications.The mechanical ventilation time of 7 days was positively correlated with the incidence of VAP in elderly patients with pulmonary tuberculosis, and 120 strains of pathogenic bacteria were isolated from elderly pulmonary tuberculosis patients with VAP.Gram-negative bacteria accounted for 71.7%, fungi accounted for 18.3, Gram-positive bacteria accounted for 10.0%, and the main gram-negative bacteria were resistant to cefoperazone / sulbactam, imipenem, meropenem and aztreonam.Conclusion the independent risk factors of VAP in elderly pulmonary tuberculosis patients are mainly Gram-negative bacteria and fungi. The incidence of mixed infection is high and the drug resistance is high.
【作者单位】：长春市传染病医院检验科;长春市妇产科医院检验科;吉林省临床检验中心血液科;
【基金】：卫生部医药卫生发展研究基金资助项目(W2013GJ09) 吉林省卫生厅科研基金资助项目(2013Z067)
【分类号】：R521

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