摘要
目的探讨下呼吸道感染(LRTIs)老年住院患者病原学特点和预后相关因素。方法回顾航天中心医院2021年7月至2022年12月118例60岁及以上LRTIs住院患者的临床特征、实验室指标和肺泡灌洗液(BALF)病原菌特点;依据疾病转归分为预后良好组(69例)和预后不良组(49例)。另收集同期住院、年龄相当、BALF检测阴性且无感染征象的60例患者作为对照组。采用单因素分析、多因素Logistic回归分析预后相关因素。结果LRTIs患者BALF共分离169株病原菌。其中革兰阴性菌112株(66.3%),革兰阳性菌16株(9.5%),真菌41株(24.3%);前3位病原菌为肺炎克雷伯菌40株、铜绿假单胞菌30株和鲍曼不动杆菌20株,对亚胺培南和美罗培南耐药率分别为70.0%和67.5%、50.0%和46.7%以及95.0%和95.0%。预后良好与预后不良组的年龄、机械通气率、抗生素使用及合并≥3种基础病差异有统计学意义(Z或χ^(2)=-3.36、12.18、6.56、6.95,P均<0.05)。不良组的中性粒细胞百分比、中性粒与淋巴细胞比值(NLR)、C反应蛋白/白蛋白和降钙素原显著高于良好组(Z=-4.67、-4.94、-1.96、-3.46,P均<0.05),而淋巴细胞百分比、白蛋白低于良好组(Z=-4.91、-3.39,P均<0.05)。多因素Logistic回归分析示高龄、机械通气、高NLR和低ALB是预后不良的独立危险因素(OR=1.07、7.02、1.09、0.83,P均<0.05)。结论老年住院患者LRTIs以革兰阴性菌为主,耐药率高;高龄、机械通气、高NLR和低ALB是预后不良的危险因素,应尽早识别。
Objective To study the pathogenic characteristics and drug resistance from bronchoalveolar lavage fluid(BALF)in elderly inpatients with lower respiratory tract infections(LRTIs),and to analyze the prognostic factors of LRTIs for early clinical intervention.Methods We retrospectively analyzed the clinical data and the results of bacteria culture of 118 elderly hospitalized patients diagnosed with LRTIs in Aerospace Central Hospital from July,2021 to December,2022.LRTIs patients were divided into a good prognosis group and a poor prognosis group.In addition,60 cases of non-LRTIs with the same age and no signs of infection in other organs were collected as the control group.We investigated the prognostic factors of LRTIs by univariate analysis and multivariate logistic regression analysis.Results A total of 169 pathogenic bacteria were isolated from the BALF specimens,including 112 strains of Gram-negative bacteria(66.3%),16 strains of Gram-positive bacteria(9.5%)and 41 strains of fungus(24.3%).The top 3 were Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.Their resistance rates to imipenem and meropenem reached 70.0%and 67.5%,50.0%and 46.7%,and both 95.0%,respectively.Univariate analysis showed that the difference of age,mechanical ventilation,use of antibiotic and basic disease≥3 were statistically significant(Z orχ^(2)=-3.36,12.18,6.56,6.95;P<0.05).Levels of neutrophil percentage,neutrophil-to-lymphocyte ratio(NLR),C reactive protein to albumin ratio and procalcitonin in poor prognosis group were significantly higher than those in good prognosis(Z=-4.67,-4.94,-1.96,-3.46;P<0.05),while levels of lymphocyte percentage and albumin were significantly lower(Z=-4.91,-3.39;P<0.05).The logistic regression analysis showed that advanced age,mechanical ventilation,high NLR and hypoalbuminemia were independent risk factors for elderly LRTIs patients(OR=1.07,7.02,1.09,0.83;P<0.05).Conclusion The major pathogen of elderly LRTIs patients is Gram-negative bacteria with severe resistance rate.Prognostic factors of elderly LRTIs patients should be identified early.
作者
齐天琪
杨靖娴
吴秀镯
高倩
QI Tianqi;YANG Jingxian;WU Xiuzhuo;GAO Qian(Department of Clinical Laboratory,Aerospace Central Hospital,Beijing 100049,China)
出处
《标记免疫分析与临床》
CAS
2023年第3期373-379,共7页
Labeled Immunoassays and Clinical Medicine
基金
北京市卫生健康委员会重点学科建设项目。
关键词
下呼吸道感染
肺泡灌洗液
病原菌
危险因素
Lower respiratory tract infections
Bronchoalveolar lavage fluid
Pathogen
Prognostic factors
