浙江省某院5年来老年社区获得性肺炎的病原体变迁及危险因素分析

发布时间：2018-07-10 09:07

本文选题：社区获得性肺炎 + 肺炎链球菌　；参考：《中国全科医学》2014年13期

【摘要】：目的了解我院老年社区获得性肺炎(CAP)的病原体和耐药性变迁,分析CAP发病的高危因素,为老年CAP的预防和治疗提供指导意见。方法回顾性分析2008—2012年的315例老年CAP患者的资料,对痰标本进行培养、分离和鉴定,药敏试验采用K-B法。对相关危险因素进行单因素和多因素Logistic回归分析。结果 315份痰标本病原体培养阳性113份,阳性率为35.9%,2008—2012年各年阳性率分别为36.2%(21/58)、33.9%(19/56)、36.1%(22/61)、36.4%(24/66)和36.5%(27/74),差异无统计学意义(χ2=0.574,P0.05);共分离出130株病原体,革兰阳性菌43株(占33.1%),革兰阴性菌51株(占39.2%),非典型病原体36株(占27.7%)。其中分布最多的4种病原体为肺炎链球菌、肺炎支原体、流感嗜血杆菌和肺炎克雷伯菌,分别占23.9%、20.8%、15.4%和14.6%。2008—2012年肺炎链球菌(由34.8%下降至18.8%)和流感嗜血杆菌(由26.1%下降至9.4%)的比重逐年下降,肺炎克雷伯菌(由8.7%上升至18.8%)和肺炎支原体(由13.0%上升至31.3%)逐年上升;肺炎链球菌对青霉素的耐药率在5年都很高,且在后2年达到100%。多因素Logistic回归分析显示年龄、吸烟史、烟龄、慢性阻塞性肺疾病(COPD)、哮喘、慢性支气管炎、肺结核、支气管扩张和肺癌是CAP的独立危险因素(P0.05)。结论本地区老年CAP的病原体构成和耐药性均发生了明显变迁,由以往以肺炎链球菌为主,逐渐变为以肺炎支原体为主,耐药性增强且呈多重耐药特点;吸烟和呼吸道疾病是老年CAP的高危因素。
[Abstract]:Objective to investigate the changes of pathogens and drug resistance in elderly patients with community-acquired pneumonia (CAP), and to analyze the high risk factors of CAP in order to provide guidance for the prevention and treatment of CAP in the elderly. Methods the data of 315 senile CAP patients from 2008 to 2012 were analyzed retrospectively. Sputum samples were cultured, isolated and identified. K-B method was used for drug sensitivity test. Univariate and multivariate logistic regression analysis was used to analyze the risk factors. Results in 315 sputum specimens, 113 were positive for pathogens, the positive rates were 36.2% (21 / 58) or 36.9% (19 / 56), 36.4% (24 / 66) and 36.5% (27 / 74), respectively, in 2008-2012. There was no significant difference (蠂 2 0.574 P 0.05). There were 43 Gram-positive bacteria (33.1%), 51 Gram-negative bacteria (39.2%) and 36 atypical pathogens (27.7%). The four most distributed pathogens were Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae. The proportions of Streptococcus pneumoniae (from 34.8% to 18.8%) and Haemophilus influenzae (from 26.1% to 9.4%) decreased year after year, while Klebsiella pneumoniae (from 8.7% to 18.8%) and Mycoplasma pneumoniae (from 13.0% to 31.3%) increased year by year. Streptococcus pneumoniae resistance to penicillin was high in 5 years and reached 100 in the latter two years. Multivariate logistic regression analysis showed that age, smoking history, smoking age, chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis, pulmonary tuberculosis, bronchiectasis and lung cancer were independent risk factors of CAP (P0.05). Conclusion the pathogen composition and drug resistance of senile CAP in this area have changed obviously from Streptococcus pneumoniae to mycoplasma pneumoniae. Smoking and respiratory diseases are high risk factors for CAP in the elderly.
【作者单位】：浙江省绍兴市人民医院综合病房;
【分类号】：R563.1

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