2020—2022年徐州地区某医院老年呼吸道感染患者流行病学特征分析
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盛宁宁,本科,副主任医师,主要研究方向:肺部肿瘤防治

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R181

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Elderly respiratory tract infection cases in a hospital in Xuzhou Area in 2020 -2022
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    摘要:

    目的 探究2020—2022年徐州地区中国人民解放军陆军第七十一集团军医院和徐州医科大学附属医院老年呼吸道感染患者的流行病学特征分析。 方法 筛选2020年5月至2022年12月中国人民解放军陆军第七十一集团军医院和徐州医科大学附属医院呼吸道感染(respiratory tract infection , RTI)患者病例,将符合标准的548例纳入研究。分析患者病例资料,了解患者症状、病原体分布、不同筛选条件下(年龄、疾病、季节)患者分布差异。 结果 超90.00%的纳入RTI患者出现咳嗽、咳痰、湿啰音症状,胸腔积液较少见。合并症前三分别是心血管疾病(153例,27.92%)、脑血管疾病(133例,24.27%)和消化性疾病(105例,19.16%)。548例老年患者呼吸道病原检测全部阳性(100.00%)。单项病原体感染540例(98.54%),混合感染8例(1.46%)。其中单项病原体感染前五分别为铜绿假单胞菌(92例,16.76%)、大肠埃希氏菌(78例,14.21%)、耐药金黄色葡萄球菌(69例,12.57%)、肺炎克雷伯氏菌(65例,11.84%)和肺炎支原体(46例,8.38%)。>90岁患者呼吸道病原体检出率最高,其主要病原体为铜绿假单胞菌、肺炎克雷伯氏菌和耐药金黄色葡萄球菌。其次86-91岁和81-85岁年龄患者病原体检出率较高,与>90岁患者不同,这两组患者大肠埃希氏菌检出率较高。与其他年龄段不同,<75岁患者乙型流感病毒检出率占比较高。肺炎发生率最高,占45.62%(250例)。大肠埃希氏菌在急性支气管炎/发作、肺炎中检出率最高,呼吸道合胞病毒在喘息性支气管炎中检查率最高,肺炎克雷伯氏菌在支气管肺炎中检出率最高,铜绿假单胞菌在发热中检出率最高。秋季病原体检出率最高(36.50%),其次是春季(27.01%)。各季节病原体感染分布与病原学检测结果匹配。草绿色链球菌秋季感染最多(c2 =20.33, P<0.001)。结论 本地区老年呼吸道感染多见于90岁以上患者,肺炎发生率最高,秋季为高发季节,病原体以铜绿假单胞菌、大肠埃希氏菌和耐药金黄色葡萄球菌为主。注意分辨上述特征可为本地区老年呼吸道感染早诊早治提供一定支撑。

    Abstract:

    Objective To investigate the epidemiology of elderly respiratory tract infection (RTI) cases in a hospital in Xuzhou region from 2020 to 2022. Methods The cases of RTI patients in a hospital were screened from May 2020 to December 2022, and 548 cases that met the criteria were included in the study. Patient case data were analyzed for symptoms, pathogen distribution, and differences in patient distribution under different screening conditions (age, disease, and season). Results More than 90.00% of the included RTI patients presented with symptoms of cough, sputum, wet rales and pleural effusion was less common. The top three comorbidities were cardiovascular disease (153 patients, 27.92%), cerebrovascular disease (133 patients, 24.27%), and gastrointestinal disease (105 patients, 19.16%).All 548 elderly patients tested positive for respiratory pathogens (100.00%). There were 540 cases of single pathogen infection (98.54%) and 8 cases of mixed infection (1.46%). The top five single pathogen infections were Pseudomonas aeruginosa (92 cases, 16.76%), Escherichia coli (78 cases, 14.21%), drug-resistant Staphylococcus aureus (69 cases, 12.57%), Klebsiella pneumoniae (65 cases, 11.84%), and Mycoplasma pneumoniae (46 cases, 8.38%). The highest detection rate of respiratory pathogens was found in patients >90 years old, whose main pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae and drug-resistant Staphylococcus aureus. The next highest rates of pathogen detection were found in patients aged 86-91 and 81-85 years, unlike patients >90 years, who had a higher rate of Escherichia coli detection. Unlike other age groups, patients <75 years old had a higher percentage of influenza B virus detection. The highest incidence of pneumonia was found in 45.62% (250 cases). Escherichia coli had the highest detection rate in acute bronchitis/episodes and pneumonia, respiratory syncytial virus had the highest detection rate in wheezing bronchitis, Klebsiella pneumoniae had the highest detection rate in bronchopneumonia, and Pseudomonas aeruginosa had the highest detection rate in fever. The highest detection rate of pathogens was found in fall (36.50%), followed by spring (27.01%). The distribution of pathogen infections in all seasons was matched with the results of pathogenicity testing. Streptococcus oxysporus had the highest number of infections in the fall ( χ2 =20.33, P<0.001). Conclusion Elderly respiratory tract infections in this region are most common in patients over 90 years old, with the highest incidence of pneumonia and high incidence in fall, and the pathogens are mainly Pseudomonas aeruginosa, Escherichia coli and drug-resistant Staphylococcus aureus. Attention to distinguish the above characteristics can provide some support for early diagnosis and treatment of respiratory infections in the elderly in this region.

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  • 收稿日期:2024-12-03
  • 最后修改日期:2024-12-03
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  • 在线发布日期: 2025-01-15
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