【摘要】 目的研究成人革兰阴性杆菌社区获得性肺炎(CAP)的临床特征及危险因素,为正确诊断革兰阴性杆菌CAP和合理应用抗菌药物提供理论依据。方法收集2003年9月～2009年9月间的CAP患者共552例。收集病人发病时的临床资料,取患者痰标本进行常规细菌培养,应用SPSS12.0对CAP危险因素进行单因素和多因素Logistic分析。结果 CAP患者中革兰阴性杆菌感染57例,占10.3%(57/552);单因素分析筛选出年龄≥65岁、合并支气管扩张、合并心衰、合并神经系统疾病、3月内应用抗菌药、呼吸频率>28次/min、中性粒细胞≥90%、BUN升高、PORT评分≥Ⅳ级等9个革兰阴性杆菌CAP可能危险因素。多因素分析筛选出合并支气管扩张症、合并神经系统疾病、呼吸频率>28次/min、中性粒细胞≥90%、3月内应用抗菌药等5个变量,可视为革兰阴性杆菌CAP的独立危险因素。结论革兰阴性杆菌感染在CAP占有一定比例,合并支气管扩张症、合并神经系统疾病、呼吸频率>28次/min、中性粒细胞≥90%、3月内应用抗菌药是革兰阴性杆菌CAP的独立危险因素。更多还原

【Abstract】 Objective To investigate the clinical presentation of and risk factors for adult community-acquired pneumonia (CAP) caused solely by Gram-negative bacilli. Methods Subjects were 552 patients with adult CAP identified from September 2003 to September 2009. Clinical data upon onset were recorded. Sputum was cultured and microorganisms were identified in accordance with standard methods. Univariate analysis and multiple logistic regression analysis were performed using SPSS 12.0 software. Results Of the 552 patients,57 had CAP caused by Gram-negative bacilli. Univariate analysis identified 9 risk factors:age ≥65 years old,also suffering from bronchiectasis,heart failure,or a central nervous system disease,undergoing antibacterial therapy in the past 3 months,respiratory rate >28/min,neutrophil count ≥90%,blood urea nitrogen level ≥30 mg/dl,and PORT classification ≥Ⅳ. Multiple logistic regression analysis identified also suffering from bronchiectasis or a central nervous system disease,respiratory rate >28/min,neutrophil count≥90%,and undergoing antibacterial therapy in the past 3 months as independent risk factors for CAP caused by Gram-negative bacilli. Conclusion Gram-negative bacilli are often detected in patients with adult CAP. Also suffering from bronchiectasis or a central nervous system disease,respiratory rate >28/min,neutrophil count≥90%,and undergoing antibacterial therapy in the past 3 months were independent risk factors for CAP caused by Gram-negative bacilli.更多还原