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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (02) : 166 -170. doi: 10.3877/cma.j.issn.1674-6902.2022.02.006

论著

医院获得性铜绿假单胞菌肺炎危险因素分析
孙康1, 李王平1, 潘蕾1,†(), 金发光1   
  1. 1. 710032　西安，空军军医大学唐都医院呼吸与危重症医学科
  • 收稿日期:2021-08-23 出版日期:2022-04-25
  • 通信作者: 潘蕾
  • 基金资助:
    陕西省科技计划项目(2020SF-112)

Risk factorsanalysis for hospital-acquired pneumonia caused by Pseudomonas aeruginosa

Kang Sun1, Wangping Li1, Lei Pan1,†(), Faguang Jin1   

  1. 1. Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi′an 710032, China
  • Received:2021-08-23 Published:2022-04-25
  • Corresponding author: Lei Pan
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引用本文：

孙康, 李王平, 潘蕾, 金发光. 医院获得性铜绿假单胞菌肺炎危险因素分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(02): 166-170.

Kang Sun, Wangping Li, Lei Pan, Faguang Jin. Risk factorsanalysis for hospital-acquired pneumonia caused by Pseudomonas aeruginosa[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(02): 166-170.

目的

分析医院获得性铜绿假单胞菌肺炎的危险因素，指导初始经验性抗菌治疗。

方法

选择空军军医大学第二附属医院2019年1月至2019年6月的所有医院获得性革兰阴性杆菌肺炎(GNB-HAP)患者374例，根据细菌培养结果分为医院获得性铜绿假单胞菌肺炎组(PA-HAP)81例，医院获得性非铜绿假单胞菌肺炎组(non-PA-HAP)293例，在获得呼吸道合格标本当天对变量进行评估，将单因素分析P<0.05的自变量纳入多因素Logistic回归分析，找到因变量的危险因素。

结果

在单因素分析中，与PA-HAP相关的潜在危险因素包括呼吸道标本收集日期距离住院日的天数、未入住ICU、未接受脑科手术、无颅腔引流管、无昏迷、无误吸风险、无脑梗塞、无脑出血、胸科手术、留置胸腔引流管、布地奈德吸入、肿瘤、脾切除术。多因素Logistic回归分析确定PA-HAP的独立危险因素：胸科手术[adjusted odds ratio (aOR) 2.462, 95%CI 1.237~4.900]、无昏迷(2.516, 1.368~4.627)、布地奈德吸入(1.883, 1.049~3.393)、脾切除术(5.039 , 1.051~24.154)。

结论

住院期间伴有胸科手术、吸入布地奈德、脾切除术而无昏迷的GNB-HAP患者应警惕铜绿假单胞菌感染。

关键词: 医院获得性肺炎, 革兰阴性杆菌, 铜绿假单胞菌, 危险因素, 经验性抗菌治疗
Objective

To analyze the risk factors of hospital-acquired pneumonia caused by Pseudomonas aeruginosa, so as to guide the initial empirical antimicrobial treatment.

Methods

All of 374 patients with hospital acquired pneumonia caused by Gram-negative bacilli(GNB-HAP) in our hospital during January 2019 to June 2019 were included in the study. Patients were divided into hospital acquired Pseudomonas aeruginosa pneumonia group (81 cases) and hospital acquired non-Pseudomonas aeruginosa pneumonia group (293 cases) according to whether the bacterial culture results were Pseudomonas aeruginosa. The variables were assessed on the day when qualified respiratory specimens were obtained. Variables with a P<0.05 in univariable analysis were then included in the multivariablelogistic regression analysis to find the independent risk factor of PA-HAP.

Results

The potential risk factors associated with PA-HAP in the univariate analysiswere Days from the specimens collection date to the date in hospital; no admission to ICU, no Cerebral surgery, no cranial drainage, no coma, no risk of aspiration, no cerebral infarction, no cerebral hemorrhage, thoracic surgery; thoracic drainage; budesonide inhalation; tumor; splenectomy. Theindependent risk factors of PA-HAP determined by multivariate logistic regression analysis included thoracic surgery [adjusted odds ratio (aOR) 2.462, 95%CI 1.237~4.900]; no coma(2.516, 1.368~4.627); budesonide inhalation (1.883, 1.049~3.393); splenectomy (5.039, 1.051~24.15).

Conclusions

Pseudomonas aeruginosa infection should be on alert in patients with GNB-HAP who have thoracic surgery, inhaled budesonide, splenectomy and no coma during hospitalization.

Key words: Hospital acquired pneumonia, Gram-negative bacilli, Pseudomonas aeruginosa, Risk factors analysis, Empirical antibiotic therapy
表1 PA-HAP组与非PA-HAP组患者来源科室概貌[n(%)]
科　室 PA-HAP组 Non-PA-HAP组
脑外科 15(18.5) 88(30.0)
胸外科 25(30.8) 40(13.7)
呼吸内科 13(16) 54(18.4)
中心ICU 8(9.8) 33(11.3)
血液科 5(6.2) 12(4.1)
神经内科 5(6.2) 16(5.4)
感染科 2(2.5) 12(4.1)
中医科 1(1.2) 11(3.8)
其他 7(8.6) 27(9.2)
表2 PA-HAP组与non-PA-HAP组临床资料比较
临床资料 PA HAP组(n＝81) Non-PA HAP组(n＝293) P值 临床特点 PAHAP组(n＝81) Non-PA HAP组(n＝293) P值
性别(男/女) 63/18 211/82 0.300 肺间质纤维化 4 26 0.248
年龄(岁)     0.197 COPD 22 59 0.174
  ≤45 15 41   肺大疱 8 29 0.996
  ≤65 42 146   支扩 8 13 0.096
  >65 24 106   胸腔积液 23 78 0.750
夏秋季节(5~10月) 57 192 0.414 肺癌 14 29 0.065
吸烟     0.717 阻塞性肺炎 3 14 0.913
  无 39 152   冠心病 12 36 0.547
  <30包年 19 58   心功能衰竭 5 22 0.681
  ≥30包年 18 62   胸部创伤 7 28 0.803
  ≥60包年 5 21   血液系统肿瘤 5 12 0.622
饮酒 20 61 0.454 实体肿瘤 29 76 0.080
外院转入 15 65 0.476 肿瘤 34 88 0.042
呼吸道标本收集日期距离住院日的天数     脑梗塞 5 52 0.010
  <7 d 26 141 0.035 脑出血 17 95 0.047
  ≥7 d 35 89   颅脑创伤 10 48 0.374
  ≥14 d 20 63   脑炎 1 6 0.988
入住ICU 42 194 0.016 高血压3级 17 84 0.168
气管插管 52 191 0.869 前列腺增生症 6 19 0.769
机械通气 48 179 0.765 肾囊肿 9 21 0.247
全麻手术 36 125 0.774 肝囊肿 8 28 0.931
胸科手术 19 25 0.000 骨盆/股骨骨折 2 7 1.000
脑科手术 15 94 0.017 脾切除术 4 3 0.042
最近3个月内入ICU史 3 13 1.000 肾功能不全 4 9 0.639
留置胃管 54 206 0.529 布地奈德吸入 27 65 0.046
留置尿管 54 214 0.260 抑酸剂 58 218 0.612
深静脉置管 34 114 0.617 白细胞计数增高 44 163 0.837
血液净化治疗 2 17 0.389 白细胞计数降低 5 11 0.341
胸腔引流管 25 48 0.004 淋巴细胞计数降低 21 87 0.508
支气管镜 49 166 0.536 单核细胞计数增高 56 215 0.449
颅腔引流管 12 85 0.010 中性粒细胞计数增高 47 180 0.578
昏迷 19 129 0.001 血小板计数升高 13 35 0.328
误吸风险 46 209 0.013 血红蛋白计数降低 50 171 0.585
免疫力低下 39 137 0.824 血浆白蛋白降低 48 165 0.636
休克 12 61 0.228 血浆球蛋白增高 15 54 0.986
呼吸衰竭 29 127 0.223 血肌酐增高 11 34 0.628
糖尿病 10 39 0.820 血尿素氮增高 19 97 0.097
表3 PA-HAP潜在危险因素
临床资料 PA-HAP组(n＝81) Non-PA-HAP组(n＝293) P值
呼吸道标本收集日期距离住院日的天数    
  <7 d 26 141 0.035
  ≥7 d 35 89  
  ≥14 d 20 63  
入住ICU 42 194 0.016
胸科手术 19 25 0.000
脑科手术 15 94 0.017
胸腔引流管 25 48 0.004
颅腔引流管 12 85 0.010
昏迷 19 129 0.001
误吸风险 46 209 0.013
肿瘤 34 88 0.042
脑梗塞 5 52 0.010
脑出血 17 95 0.047
脾切除术 4 3 0.042
布地奈德吸入 27 65 0.046
表4 PA-HAP独立危险因素
独立危险因素 OR(95%CI) P值
胸科手术 2.462 (1.237，4.900) 0.010
无昏迷 2.516 (1.368，4.627) 0.003
布地奈德吸入 1.833 (1.049，3.393) 0.035
脾切除术 5.039 (1.051，24.154) 0.043
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