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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
谢朝云,李耀福,蒙桂鸾,金成真,王有才.老年慢性支气管炎急性期住院患者多重耐药菌感染的相关因素[J].中华老年多器官疾病杂志,2020,19(7):520~524
老年慢性支气管炎急性期住院患者多重耐药菌感染的相关因素
Factors associated with multi-drug-resistant bacterial infections in elderly inpatients with acute attack of chronic bronchitis
投稿时间:2019-08-12  
DOI:10.11915/j.issn.1671-5403.2020.07.123
中文关键词:  老年人;慢性支气管肺炎急性期;多重耐药菌;相关因素;logistic回归分析
英文关键词:aged; acute attack of chronic bronchitis; multidrug-resistant bacteria; associating factors; logistic regression analysis This work was supported by the Joint Project of Guizhou Provincial Science and Technology Department
基金项目:贵州省科技厅联合项目(黔科合LH字[2014]7162号),贵州省黔南州社会发展科技项目(黔南科合社字[2018]7号)
作者单位E-mail
谢朝云 贵州医科大学第三附属医院感染管理科,贵州 都匀 558000 xcu2009@163.comfactors 
李耀福 贵州医科大学第三附属医院感染管理科,贵州 都匀 558000 xcu2009@163.comfactors 
蒙桂鸾 贵州医科大学第三附属医院感染管理科,贵州 都匀 558000 xcu2009@163.comfactors 
金成真 贵州医科大学第三附属医院 呼吸内科,贵州 都匀 558000 xcu2009@163.comfactors 
王有才 贵州医科大学第三附属医院 呼吸内科,贵州 都匀 558000 xcu2009@163.comfactors 
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中文摘要:
      目的 分析老年慢性支气管炎急性期住院患者多重耐药菌(MDROs)感染影响因素,为临床防控提供参考。方法 纳入2015年9月至2019年5月收治的313例老年慢性支气管炎急性期患者,对其临床资料进行回顾性分析。分析其MDROs的感染率及感染菌株分布。对其MDROs感染影响因素进行单因素和多因素回归分析。采用SPSS 19.0软件包进行统计分析,利用单因素和多因素logistic回归模型分析老年慢性支气管肺炎急性期住院患者MDROs感染独立影响因素。结果 313例老年慢性支气管炎急性期住院患者中共有107例患者检出MDROs,感染率34.19%。临床标本中共分离出病原菌301株,其中MDROs 118株,占39.20%。单因素分析显示年龄≥70岁、糖尿病病史、入院前近6个月联合使用抗菌药物≥3种、住院时间≥14d、并发肺源性心脏病、入住重症监护病房(ICU)、糖化血经蛋白(>7%)、入院后抗菌药物使用种类≥3种、入院后联合使用抗菌药物≥3种、血糖值≥11.1mmol/L、入院后抗菌药物使用时间>7d均是老年慢性支气管炎急性期住院患者MDROs感染危险因素(P<0.05),而口腔护理与雾化吸入是老年慢性支气管炎急性期住院患者MDROs感染保护因素(P<0.05)。多因素logistic 回归分析结果表明年龄≥70岁、入院前近6个月联合使用抗菌药物≥3种、入住ICU、糖化血红蛋白>7%、入院后联合使用抗菌药物≥3种等是MDROs感染独立危险因素(P<0.05)。结论 老年慢性支气管炎急性期住院患者MDROs感染与多种因素有关,控制血糖、减少并发肺源性心脏病、关注患者入院前近期联用抗菌药物情况、减少不必要入住ICU、合理使用抗菌药物等为主的综合措施,可降低其MDROs感染率。
英文摘要:
      Objective To analyze affecting factors of multidrug-resistant (MDR) bacterial infection in elderly patients with acute attack of chronic bronchitis with a view of providing reference for clinical prevention and control. Methods The clinical data were retrospectively reviewed of 313 elderly patients with acute attack of chronic bronchitis from September 2015 to May 2019. Infection rate and distribution of infectious strains were analyzed. SPSS statistics 19.0 was used for statistical analysis. Univariate and multivariate regression analysis were performed to identify independent affecting factors of MDR bacterial infections in elderly inpatients with acute attack of chronic bronchitis. Results Of 313 elderly inpatients with acute attack of chronic bronchitis, MDR bacterial infection was detected in 107(34.19%). A total of 301 pathogenic bacteria were isolated from clinical specimens, 118(39.20%) being multidrug resistant. Univariate analysis showed that age ≥70 years, history of diabetes mellitus, combined use of antibiotics ≥ 3 kinds in the past 6 months before admission, length of hospital stay ≥ 14d, pulmonary heart disease, admission to Intensive Care Unit (ICU), glycosylated blood protein >7%, types of antibiotics ≥ 3 kinds after admission, combined use of antibiotics after admission ≥ 3 kinds,fasting blood glucose ≥ 11.1mmol/L, the time of using antibiotics after admission > 7d were the risk factors of MDROs infectionin elderly patients with chronic bronchitis at acute stage (P<0.05), while oral care and aerosol inhalation were the protective factors of MDROs infection in elderly patients with chronic bronchitis at acute stage (P<0.05). Multivariate logistic regression analysis showed that the independent risk factors of MDROs infection were age>70 years, combined use of antibiotics>3 kinds within 6 months before admission, admission to ICU, glycosylated menstrual protein>7%, and combining used antibiotics>3 kinds after admission (P<0.05). Conclusion MDR bacterial infection in elderly inpatients with acute attack of chronic bronchitis is associated with many factors, and infection rate can be reduced by controlling blood sugar, reducing complications of pulmonary heart disease, paying attention to the recent use of antibiotics before admission, reducing unnecessary admission to ICU, and rational use of antibiotics.
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