老年慢性阻塞性肺疾病急性加重合并肺部感染的病原菌分布及高危因素分析

摘要/Abstract

摘要：

目的探讨老年慢性阻塞性肺疾病（COPD）急性加重合并肺部感染的病原菌分布及高危因素。方法老年COPD急性加重患者260例按照其肺部感染发生情况分为感染组与非感染组，记录所有患者的临床资料，并对感染组患者进行病原菌分布及高危因素分析。结果 260例老年COPD急性加重患者中共发现30例肺部感染，感染率为11.5%，在感染组30例患者中，共检出病原菌45株，其中革兰阴性菌25株，革兰阳性菌18株，念珠菌2株，排名前4位的病原菌为铜绿假单胞菌、肺炎克雷伯菌、粪肠球菌、金黄色葡萄球菌等。铜绿假单胞菌、肺炎克雷伯菌对红霉素、庆大霉素有比较高的耐药率，而粪肠球菌、金黄色葡萄球菌对左氧氟沙星、美罗培南都比较高的耐药率。单因素回归分析发现感染组与非感染患者的糖尿病史、吸烟、长期使用抗菌药物、长期使用激素、长期卧床等比较差异具有统计学意义（P<0.05）；多因素非条件Logistic回归分析结果显示糖尿病史（OR=10.593，P=0.000）、吸烟（OR=6.194，P=0.008）、长期使用抗菌药物（OR=3.255，P=0.014）为导致肺部感染的高危因素（P<0.05）。结论老年慢性阻塞性肺疾病急性加重合并肺部感染比较常见，病原菌中主要为革兰阴性菌，对多种抗菌药物有耐药性，发病高危因素主要为糖尿病、吸烟与长期使用抗菌药物。

关键词: 老年人, 慢性阻塞性肺疾病, 肺部感染, 高危因素, 病原菌

Abstract:

Objective To investigate the distribution of pathogens and risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in elderly patients with pulmonary infection. Methods Two hundred and sixty elderly patients with acute exacerbation of chronic obstructive pulmonary disease in our hospital were selected. All patients were divided into infection group and non-infection group accorded to the occurrence of pulmonary infection. The clinical data of all cases were recorded, and the pulmonary infection patients were given analysis of the risk factors and the pathogens distribution. Results There were 30 patients of pulmonary infection in the 260 patients (11.5%). In the infection group, a total of 45 strains of pathogen including 25 strains of gram negative bacteria, 18 strains of gram positive bacteria, 2 strains of candida spp. were isolated. The top 4 pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus etc. The Pseudomonas aeruginosa, Klebsiella pneumoniae had relatively high rate of resistance to erythromycin, gentamicin, and the Pseudomonas aeruginosa, Staphylococcus aureus had relatively high rate of levofloxacin and meropenem. Univariate regression analysis showed that the history of diabetes, smoking, long-term use of antibiotics, long-term use of hormones, long-term bed were significant different in the infection group and in non-infection group (P<0.05); Non conditional Logistic regression analysis showed that the diabetes (OR=10.593, P=0.000), smoking (OR=6.194, P=0.008), long-term use of antibiotics (OR=3.255, P=0.014) were the risk factors of pulmonary infection (P<0.05). Conclusion Pulmonary infection was common in acute exacerbation of chronic obstructive pulmonary disease, Gram-negative bacteria might be the main pathogen. Diabetes, smoking, long-term use of antibiotics were the risk factors of pulmonary infection.

Key words: elderly, chronic obstructive pulmonary disease, pulmonary infection, high risk factors, pathogenic bacteria

中图分类号:

R563.1

韦永刚, 颜红英, 肖远红. 老年慢性阻塞性肺疾病急性加重合并肺部感染的病原菌分布及高危因素分析[J]. 中国真菌学杂志, 2018, 13(3): 177-180,183.

WEI Yong-gang, YAN Hong-ying, XIAO Yuan-hong. Pathogens distribution and risk factors of pulmonary infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Mycology, 2018, 13(3): 177-180,183.

参考文献

[1] VogelmeierC, FabbriLM, RabeKF, et al. Effect of tiotropium vs. salmeterol on exacerbations:GOLD Ⅱ and maintenance therapy naive patients[J]. Respir Med, 2013, 107(1):75-83.
[2] FinneyL, BerryM, SinganayagamA, et al. Inhaled corticosteroids and pneumonia in chronic obstructive pulmonary disease[J]. The Lancet Respiratory Medicine, 2014, 2(11):919-932.
[3] 罗兴文,魏龙.慢性阻塞性肺疾病患者医院肺部感染的相关危险因素分析[J].新疆医学,2016,46(1):39-41.
[4] 刘永娟,戚明,门浩,等.慢性阻塞性肺疾病患者肺部真菌感染与耐药性研究[J].中华医院感染学杂志,2016,21(3):578-579.
[5] Porto BN, Stein RT. Neutrophil Extracellular Traps in Pulmonary Diseases:Too Much of a Good Thing[J].Front Immunol,2016,15(7):311-319.
[6] Capistrano SJ, Zakarya R, Chen H, et al. Biomass Smoke Exposure Enhances Rhinovirus-Induced Inflammation in Primary Lung Fibroblasts[J].Int J Mol Sci,2016,17(9):64-71.
[7] HerathS, PooleP. Prophylactic antibiotic therapy in chronic obstructive pulmonary disease[J]. JAMA,2014, 311(21):2225.
[8] LoukidesS, BartziokasK, VestboJ, et al. Novel anti-inflammatory agents in COPD:targeting lung and systemic inflammation[J]. Curr Drug Targets, 2013, 14(2):235-245.
[9] Zhang JC, Chen G, Chen L, et al. TGF-β/BAMBI pathway dysfunction contributes to peripheral Th17/Treg imbalance in chronic obstructive pulmonary disease[J].Sci Rep,2016,23(6):1911-1918.
[10] Ehrmann E, Jolivet-Gougeon A, Bonnaure-Mallet M, et al. Multidrug-resistant oral Capnocytophaga gingivalis responsible for an acute exacerbation of chronic obstructive pulmonary disease:Case report and literature review[J].Anaerobe,2016,13(42):50-54.
[11] 胡俊芳,罗敏,王挺.慢性阻塞性肺疾病下呼吸道感染病原学分析及抗生素选择[J].西部医学,2016,28(1):74-76,83.
[12] CrinerGJ, ConnettJE, AaronSD, et al. Simvastatin for the prevention of exacerbations in moderate-to-severe COPD[J]. N Engl J Med, 2014, 370(23):2201-2210.
[13] Aleva FE, Voets LW, Simons SO, et al.Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD:A systematic review and meta-analysis[J].Chest,2016,92(16):752-760.
[14] Chen HF, Homan S, Carlson E, et al. The Impact of Race and Neighborhood Racial Composition on Preventable Readmissions for Diabetic Medicare Home Health Beneficiaries[J].J Racial Ethn Health Disparities,2016,8(11):389-392.
[15] Duell BL, Su YC, Riesbeck K. Host-pathogen interactions of nontypeable Haemophilus influenzae:from commensal to pathogen[J].FEBS Lett,2016,8(10):518-522.
[16] Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases:implications for the elderly[J].Periodontol,2016,72(1):153-175.
[17] Zheng JP, Wen FQ, Bai CX, et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON):a randomised, double-blind placebo-controlled trial[J]. Lancet Respir Med, 2014, 2(3):187-194.
[18] Huang JT, Bolton CE, Miller BE, et al. Age-dependent elastin degradation is enhanced in chronic obstructive pulmonary disease[J].Eur Respir J,2016,9(1):547-552.
[19] Kim JH, Park S, Hwang YI, et al.Immunoglobulin G Subclass Deficiencies in Adult Patients with Chronic Airway Diseases[J].J Korean Med Sci,2016,31(10):1560-1565.
[20] Kim RY, Rae B, Neal R, et al. Elucidating novel disease mechanisms in severe asthma[J].Clin Transl Immunology,2016,5(7):91-98.