CAJ | 학술논문

目的考察影响老年医疗护理相关性肺炎(healthcare-associated pneumonia,HCAP)多重耐药(multidrug-resistance,MDR)菌感染及预后的因素.方法前瞻性收集2007年1月至2012年1月间因HCAP住院、年龄≥65岁患者的下呼吸道、血、胸水等标本,行病原学鉴定,观察MDR比例,Logistic回归筛选与MDR感染及死亡相关的危险因素.结果 286例获得病原学诊断患者中,MDR感染121例(42.3％).在HCAP定义的各种危险因素中,90 d内住院、家庭医疗护理、病情危重和前期应用抗生素为MDR感染的独立危险因素.死亡与患者年龄、家庭护理/医疗护理机构居住、肺炎严重指数、简易急性生理评分Ⅱ、未及时抗生素治疗密切相关,而与MDR感染及是否依从指南选择抗生素治疗无关.结论 MDR感染仅占老年HCAP的一部分,且与患者死亡无必然的联系.HCAP定义的各种危险因素在预测MDR感染时差别较大,应探索更有效的方法评估HCAP中MDR的感染.
목적 고찰영향노년의료호리상관성폐염(healthcare-associated pneumonia,HCAP)다중내약(multidrug-resistance,MDR)균감염급예후적인소.방법 전첨성수집2007년1월지2012년1월간인HCAP주원、년령≥65세환자적하호흡도、혈、흉수등표본,행병원학감정,관찰MDR비례,Logistic회귀사선여MDR감염급사망상관적위험인소.결과 286례획득병원학진단환자중,MDR감염121례(42.3％).재HCAP정의적각충위험인소중,90 d내주원、가정의료호리、병정위중화전기응용항생소위MDR감염적독립위험인소.사망여환자년령、가정호리/의료호리궤구거주、폐염엄중지수、간역급성생리평분Ⅱ、미급시항생소치료밀절상관,이여MDR감염급시부의종지남선택항생소치료무관.결론 MDR감염부점노년HCAP적일부분,차여환자사망무필연적련계.HCAP정의적각충위험인소재예측MDR감염시차별교대,응탐색경유효적방법평고HCAP중MDR적감염.
Objective To assess risk factors of infection due to multidrug-rcsistant (MDR) pathogens and outcomes among elderly patients with healthcare-associated pneumonia (HCAP).Methods A prospective study was conducted in consecutive patients hospitalized with HCAP,aged ≥65 years old,from January 2007 to January 2012.Sample of the lower respiratory tract (sputum and bronchoalveolar lavage fluid),serum and pleural effusion were collected and detected for MDR.Logistic regression models were used to evaluate independent risk factors for acquiring MDR bacteria and inhospital mortality.Results Among the 286 patients,a total of 121 (42.3％) MDR pathogens were recovered.Of all risk factors,hospitalization in the preceding 90 days,prior antibiotics therapy,intensive care unit admission and residency in a nursing home were independent predictors for infection with MDR pathogens.Age,pneumonia severity index,simplified acute physiology score Ⅱ and residency in a nursing home were also independent predictors for inhospital mortality,but MDR and nonadherence to guidline were not associated with mortality.Conclusions MDR pathogens account partly for HCAP among elderly patients,and are not associated with mortality.The pratical roles of risk factors included in the HCAP definition are considerably different in predicting infection due to MDR bacteria and outcomes,and a probabilistic method to identify MDR pathogens among patients with HCAP should be explored.