破伤风患者合并医院获得性肺炎的危险因素及病原菌

Risk factors and pathogen distribution of hospital-acquired pneumonia in patients with tetanus

摘要:

目的 分析破伤风患者合并医院获得性肺炎(HAP)的危险因素及病原菌分布,为临床医生防控及治疗此类患者提供参考依据。方法 收集2014年1月—2019年6月西南医科大学附属医院感染科收治的破伤风患者的临床资料,根据是否发生HAP分为两组,统计病原菌分布,分析破伤风患者合并HAP的危险因素。结果 75例破伤风患者,发生HAP者44例(58.7%),死亡11例患者均合并HAP。破伤风患者合并HAP危险因素单因素分析显示,HAP组患者年龄≥60岁、长期吸烟、合并慢性肺疾病、Ablett分级≥Ⅲ级、气管切开的比例均高于非HAP组患者(均P<0.05);logstic回归多因素分析显示,长期吸烟(OR=7.00,95%CI:1.17~41.91)、合并慢性肺疾病(OR=9.84,95%CI: 1.37~70.52)、Ablett分级≥Ⅲ级(OR=24.53,95%CI:3.81~157.76)是破伤风患者合并HAP的独立危险因素。44例患者分离出病原菌24株,以铜绿假单胞菌(8株)、肺炎克雷伯菌(7株)等革兰阴性菌为主。结论 破伤风患者合并HAP的发生率高,HAP病原菌以革兰阴性菌为主。长期吸烟、合并慢性肺疾病、Ablett分级≥Ⅲ级的破伤风患者易发生HAP。

Abstract:

Objective To analyze risk factors and pathogen distribution of hospital-acquired pneumonia (HAP) in patients with tetanus, and provide reference for clinicians to prevent and control HAP in such patients. Methods Clinical data of patients with tetanus who were admitted to the department of infectious diseases of Affiliated Hospital of Southwest Medical University from January 2014 to June 2019 were collected, patients were divided into two groups according to whether they had developed HAP, distribution of pathogens was analyzed, and risk factors for HAP in patients with tetanus were statistically analyzed. Results Of 75 patients with tetanus, 44 (58.7%) had HAP, 11 death patients all developed HAP. Univariate analysis on risk factors for HAP in patients with tetanus showed that the proportion of age ≥ 60 years, long-term smoking, chronic lung disease, Ablett grade ≥ Ⅲ and tracheo- tomy in patients in HAP group were all higher than those in non-HAP group (all P<0.05); logistic regression analysis showed long-term smoking(OR=7.00, 95% CI:1.17-41.91), chronic lung disease(OR=9.84,95% CI:1.37-70.52), Ablett grade ≥ Ⅲ (OR=24.53, 95% CI:3.81-157.76) were independent risk factors for HAP in patients with tetanus. 24 strains of pathogens were isolated from 44 patients, pathogens were mainly Gram-negative bacteria such as Pseudomonas aeruginosa (n=8 strains) and Klebsiella pneumoniae (n=7 strains). Conclusion Incidence of HAP in patients with tetanus is high, pathogens are mainly Gram-negative bacteria. Tetanus patients with long-term smoking, chronic lung disease and Ablett grade ≥ Ⅲ are easily to develop HAP.