The analysis of related factors for multiple bacterial infection in elderly patients with health care-related pneumonia / 中华老年医学杂志

ABSTRACT

Objective:To analyze the related factors for plural bacterial infection in elderly patients with health care-associated pneumonia(HCAP), in order to provide the reference for clinical practice.Methods:A total of the 1 012 elderly patients conforming to inclusion criteria were in the age of 60-87(70.7±6.2)years, with 431 cases of males and 581 cases of females.The clinical data of elderly patients with HCAP admitted to our hospital from February 2015 to December 2018 were collected.According to the number of infected bacteria category, the patients were divided into the single bacterial infection group and the plural bacterial infection group.The distribution of pathogens was compared between the two groups, and the related factors for plural bacterial infection were analyzed.Results:There were 122 HCAP cases in the plural bacterial infection group, with 286 strains of pathogenic bacteria detected, while 890 HCAP cases were found in the single bacterial infection group, with 890 strains of pathogenic bacteria detected.Compared with the single infection group, the plural bacteria infection group showed that the proportions of Gram-positive Staphylococcus aureus and Enterococcus faecium were increased, while the proportion of Staphylococcus epidermidis was relatively decline( χ2=11.086, 8.460 and 4.056, P=0.001, 0.004 and 0.044). The proportions of Gram-negative Pseudomonas aeruginosa and Stenotrophomonas maltophilia were higher, while the proportions of Escherichia coli and Klebsiella were lower in the plural bacteria infection group than in the single bacteria infection group( χ2=7.495, 4.918, 9.011 and 4.604, P=0.006, 0.027, 0.003 and 0.032). Multivariate Logistic regression analysis showed that the independent risk factors for plural bacteria infection in elderly HCAP patients were the combined use of antibiotics within 30 days(≥3 kinds), more chronic underlying diseases(≥2 kinds), pneumonia severity index(PSI)classification being high, longer hospitalization time within 90 days(≥15 days), a history of ICU stays within 90 days, age(≥70 years old)( OR=2.389, 1.840, 1.289, 1.877, 2.089 and 1.981, P=0.001, 0.003, 0.001, 0.002, 0.001 and 0.002, respectively). Conclusions:The plural bacteria infection in elderly HCAP patients is related to many factors.The effective measure to reduce the plural bacteria infection in elderly HCAP patients are to focus on patients with severe disease, more basic diseases and advanced age, and on the shortening of the unnecessary hospitalization time, the reducing of the time of ICU stays, the reasonably selecting of antibiotics, the reducing of the unnecessary combination of antibacterial drugs.