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目的:探讨社区获得性肺炎(CAP)并发革兰阴性菌感染的病原菌分布及危险因素,以降低感染率。方法:选择2013年6月到2015年6月我院确诊CAP患者80例,收集所有患者的临床资料,分析CAP并发革兰阴性菌感染的病原菌分布及危险因素。结果:CAP并发革兰阴性菌感染的病原菌以肺炎克雷伯菌株数最多,13株(占30.23%),其次为大肠埃希菌8株(占18.60%)和鲍曼不动杆菌7株(占16.28%)。感染阳性组入院治疗前使用抗生素、白细胞水平异常、PORT≥3级以及血尿素氮水平>7.1 mmol/L的比例较感染阴性组显著更高,差异均有统计学意义(均P<0.05)。由Logistic回归分析可知,入院治疗前使用抗生素、白细胞水平异常、PORT≥3级以及血尿素氮水平>7.1 mmol/L均为影响CAP患者发生革兰阴性菌感染的危险因素。结论:CAP并发革兰阴性菌感染的病原菌主要以肺炎克雷伯菌,大肠埃希菌和鲍曼不动杆菌为主,临床上应重视CAP并发革兰阴性菌感染危险因素,以降低感染率。
Objective: To investigate the distribution and risk factors of pathogenic bacteria in community-acquired pneumonia (CAP) complicated with Gram-negative bacteria infection in order to reduce the infection rate. Methods: From June 2013 to June 2015, 80 patients diagnosed with CAP in our hospital were selected. The clinical data of all patients were collected. The pathogen distribution and risk factors of CAP-complicated gram-negative bacteria infection were analyzed. Results: The number of Klebsiella pneumoniae isolates was the highest in CAP-associated gram-negative bacteria, of which 13 (30.23%), followed by 8 strains of Escherichia coli (18.60%) and 7 strains of Acinetobacter baumannii Accounting for 16.28%). In the positive infection group, the antibiotics, abnormal leucocyte level, PORT≥3 grade, and blood urea nitrogen level> 7.1 mmol / L were significantly higher than those in the negative control group (all P <0.05). Logistic regression analysis showed that antibiotics, abnormal leukocyte levels, PORT≥3 level and blood urea nitrogen level> 7.1 mmol / L were the risk factors of Gram-negative bacteria infection in CAP patients. CONCLUSIONS: The main pathogens of CAP-associated Gram-negative bacteria are Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii. The risk factors of CAP-associated Gram-negative bacteria infection should be emphasized clinically in order to reduce the infection rate .