文献类型：期刊文献

中文题名：糖尿病并发肺部感染患者的临床研究

英文题名：Clinical characteristics and risk factors of severe pulmonary infection in patients with diabetes mellitus

作者：朱燕[1];卢曙芳[1];斯浣菲[1];朱东方[2];蒋秀娥[3]

机构：[1]绍兴文理学院附属医院综合康复二病区,浙江绍兴312000;[2]绍兴文理学院附属医院检验科;[3]绍兴文理学院附属医院院感科

年份：2020

卷号：21

期号：10

起止页码：1107

中文期刊名：中国预防医学杂志

外文期刊名：Chinese Preventive Medicine

收录：CSTPCD、、CSCD2019_2020、CSCD

语种：中文

中文关键词：糖尿病;肺部感染;临床特点;耐药性;病原体;危险因素;预防对策

外文关键词：Diabetes mellitus;Severe pulmonary infection;Clinical characteristics;Drug resistance;Pathogens;Risk factors;Preventive measures

中文摘要：目的探究分析糖尿病并发肺部感染患者的临床特点、危险因素及预防对策。方法回顾性分析2014年4月~2018年1月接受治疗的2型糖尿病患者367例,探究分析糖尿病并发肺部感染患者的临床特点、危险因素及预防对策。结果 367例2型糖尿病患者共发现肺部感染31例,占8.45%,其中共培养出病原菌48株,其中革兰阳性菌17(35.42%)株,革兰阴性菌24(50.00%)株,真菌7(14.58%)株。革兰阴性菌中肺炎克雷伯菌对头孢吡肟、头孢噻圬、头孢唑林、阿莫西林具有较强耐药性,但对美罗培南、阿米卡星具有较好的药物敏感性。革兰阳性菌中金黄色葡萄球菌对头孢克洛、氨苄西林、四环素、头孢噻肟、头孢西丁具有较强的耐药性,对左氧氟沙星、万古霉素、替考拉宁具有较强的敏感性。白色假丝酵母菌对氟康唑、伊曲康唑具有较强的耐药性,对双性霉素B具有较强的敏感性。患者血糖控制情况较差、年龄>55岁、住院时间>10 d、未使用抗菌药物、糖尿病病程>5年、有侵入性操作是影响糖尿病患者并发肺部感染的独立危险因素(χ^2=3.7634、14.9228、28.4067、4.2699、23.9203、26.6990,P=0.0494、0.0001、<0.0001、0.0388、<0.0001、<0.0001)。结论糖尿病并发肺部感染的患者病情危重,严重影响预后。感染主要以革兰氏阴性菌为主,与住院时间、血糖水平、年龄、病程、使用药物等密切相关。临床上治疗糖尿病并发肺部感染的患者,应针对危险因素合理处置。

外文摘要：Objective To understand the clinical characteristics and risk factors of severe pulmonary infection in patients with diabetes mellitus. Methods A retrospective analysis was performed on clinical data of 367 patients with type 2 diabetes mellitus treated in our hospital from April 2014 to January 2018.The clinical characteristics, risk factors and preventive measures of severe pulmonary infection in patients with diabetes mellitus were analyzed. Results Out of 367 subjects, 31 cases had pulmonary infections with the overall infection rate of 8.45%.A total of 48 strains of pathogenic bacteria were isolated, including 17(35.42%) strains of Gram-positive bacteria, 24(50.00%) strains of Gram-negative bacteria and 7(14.58%) strains of fungi.Gram-negative bacterium Klebsiella pneumoniae was highly resistant to cefepime, cefotaxime, cefazolin and amoxicillin, while was sensitive to meropenem and amikacin.Gram-positive bacterium Staphylococcus aureus was highly resistant to cefaclor, ampicillin, tetracycline, cefotaxime and cefoxitin, while was sensitive to levofloxacin, vancomycin and teicoplanin.Candida albicans was highly resistant to fluconazole and itraconazole, while was sensitive to amphotericin B.Multivariate logistic regression analysis showed that poor blood sugar control, age of over 55 years old, longer than 10 days of hospital stay, no antibiotics treatment, having diabetes mellitus for more than 5 years and invasive procedures were major independent risk factors for severe pulmonary infection in patients with diabetes mellitus(χ~2=3.7634,14.9228,28.4067,4.2699,23.9203,26.6990;P<0.05). Conclusions Severe pulmonary infection in patients with diabetes mellitus affects the prognosis.Gram-negative bacteria are predominant pathogens for the infection.Length of hospital stay,blood sugar level,age,course of disease,medication are risk factors for the infection.Therefore,clinical treatment should be considered based on the specific risk factor.