CAJ | 학술논문

目的：分析唐山地区成人社区获得性肺炎（CAP）患者感染革兰阴性菌的危险因素，为早期识别革兰阴性菌CAP和合理用药提供借鉴。方法2011年10月—2012年9月期间，选取唐山市行政区域内6所医院呼吸内科确诊为CAP的成人住院患者530例，收集患者一般资料、体格检查、辅助检查和病原学资料，依据以上资料计算患者预后研究小组评分（PORT）；采集患者痰标本进行致病菌检测。采用单因素Logistic回归和多因素Logistic回归分析CAP患者感染革兰阴性菌的危险因素。结果530例CAP患者中，172例（32.45%）患者检测出细菌195株，其中革兰阴性菌154株（78.97%），革兰阳性菌41株（21.03%）。单因素Logistic回归分析结果显示，年龄≥65岁、入院前应用抗生素、合并基础疾病、合并脑血管疾病、营养不良、白细胞异常、中性粒细胞＜1×109/L、PORT≥Ⅲ级、总胆红素＞17.1μmol/L和血尿素氮＞7.1 mmol/L为CAP患者感染革兰阴性菌的可能危险因素。多因素Logistic回归分析结果显示，入院前应用抗生素（OR=2.327，95%CI为1.453～3.725），白细胞异常（OR=2.904，95%CI为1.879～4.490）， PORT≥Ⅲ级（OR=3.839，95%CI为2.427～6.071），血尿素氮＞7.1 mmol/L（OR=4.133，95%CI为2.585～6.606）为革兰阴性菌CAP的独立危险因素。结论入院前应用抗生素、白细胞异常、PORT≥Ⅲ级、血尿素氮＞7.1 mmol/L的CAP患者易感染革兰阴性菌，临床经验性抗感染治疗应考虑以上危险因素。
목적：분석당산지구성인사구획득성폐염（CAP）환자감염혁란음성균적위험인소，위조기식별혁란음성균CAP화합리용약제공차감。방법2011년10월—2012년9월기간，선취당산시행정구역내6소의원호흡내과학진위CAP적성인주원환자530례，수집환자일반자료、체격검사、보조검사화병원학자료，의거이상자료계산환자예후연구소조평분（PORT）；채집환자담표본진행치병균검측。채용단인소Logistic회귀화다인소Logistic회귀분석CAP환자감염혁란음성균적위험인소。결과530례CAP환자중，172례（32.45%）환자검측출세균195주，기중혁란음성균154주（78.97%），혁란양성균41주（21.03%）。단인소Logistic회귀분석결과현시，년령≥65세、입원전응용항생소、합병기출질병、합병뇌혈관질병、영양불량、백세포이상、중성립세포＜1×109/L、PORT≥Ⅲ급、총담홍소＞17.1μmol/L화혈뇨소담＞7.1 mmol/L위CAP환자감염혁란음성균적가능위험인소。다인소Logistic회귀분석결과현시，입원전응용항생소（OR=2.327，95%CI위1.453～3.725），백세포이상（OR=2.904，95%CI위1.879～4.490）， PORT≥Ⅲ급（OR=3.839，95%CI위2.427～6.071），혈뇨소담＞7.1 mmol/L（OR=4.133，95%CI위2.585～6.606）위혁란음성균CAP적독립위험인소。결론입원전응용항생소、백세포이상、PORT≥Ⅲ급、혈뇨소담＞7.1 mmol/L적CAP환자역감염혁란음성균，림상경험성항감염치료응고필이상위험인소。
Objective To analyze the clinical characteristics and risk factors for adult community-acquired pneumonia (CAP) caused by Gram-negative bacilli in Tangshan, and provide reference for the early identification of Gram-negative bac?teria CAP and the clinical use of antibiotics. Methods Data of retrospective general information, physical examination, aux?iliary examination and pathogen were collected in patients with CAP in respiratory department from 6 hospitals in Tangshan between October 2011 to September 2012. According to the above data, the prognosis of patients with the team score (PORT) was calculated. The sputum samples were isolated for pathogen identification. Univariate logistic regression analysis and multivariate logistic regression analysis were performed for risk factors of Gram-negative bacilli. Results A total of 195 strains were isolated from 172 (32.45%) patients in 530 patients with CAP. There were 154 strains of Gram-negative ba?cilli (78.97%) and 41 strains of Gram-positive bacteria (21.03%) in 195 bacterial strains. Univariate logistic regression anal?ysis showed the possible risk factors of Gram-negative bacilli in patients with CAP including age≥65 years old, using antibi?otics before hospitalization, basic diseases, cerebrovascular disease, malnutrion, white blood cell abnormal, neutrophil count<1 × 109/L, PORT classification≥Ⅲ, total bilirubin>17.1μmol/L and blood urea nitrogen>7.1 mmol/L. Multivariate logistic regression analysis showed the independent risk factors of Gram-negative bacilli in patients with CAP including us?ing antibiotics before hospitalization (OR=2.327, 95%CI 1.453-3.725), white blood cell abnormal (OR=2.904, 95%CI 1.879-4.490), PORT classification≥Ⅲ(OR=3.839, 95%CI 2.427-6.071), and blood urea nitrogen elevated (OR=4.133, 95%CI 2.585-6.606). Conclusion Clinical empirical anti-infection treatment should consider the risk factors including using antibiotics before hospitalization, white blood cell abnormal, PORT classification≥Ⅲ and blood urea nitrogen>7.1 mmol/L in patients with susceptible to Gram-negative bacteria infection.