Lv Qin, Zhang Xinliang, Guo Kucun, Hu Dezheng, Deng Zhuojun
Department of Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050051, People's Republic of China.
Department of General Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, 050000, People's Republic of China.
Infect Drug Resist. 2023 Oct 13;16:6691-6701. doi: 10.2147/IDR.S418894. eCollection 2023.
We analyzed the characteristics and risk factors for pulmonary infection in patients with spinal cord injury who underwent tracheostomy and propose measures to help in early detection and intervention to reduce mortality and improve prognosis.
We collected data retrospectively from January 1, 2018, to December 31, 2022. The inclusion criteria were: Patients aged 18 years or more with a spinal cord injury who underwent tracheostomy, were treated with mechanical ventilation for over 48 hours, and were diagnosed as having a pulmonary infection. Sputum samples were cultured and analyzed.
101 cases of pulmonary infection were analyzed, and the incidence was 32.17%. Diabetes (OR 2.302, 95% CI 1.285-3.972), hypoproteinemia (OR 1.992, 95% CI 1.125-3.101), administration of glucocorticoids (OR 2.934, 95% CI 1.412-4.661), ASIA grade A (OR 3.672, 95% CI 1.988-5.046), mechanical ventilation for ≥ 6 days (OR 2.108, 95% CI 1.385-4.751), and length of hospital stay for ≥ 20 days (OR 2.137, 95% CI 1.092-3.842) were risk factors for pulmonary infection in patients with spinal cord injury post-tracheostomy. Among 213 pathogenic bacteria, 52 (51.48%) were Gram-negative and 24 (23.76%) were Gram-positive. Klebsiella pneumoniae (15.84%) and Staphylococcus aureus (8.91%) were the most common pathogenic bacteria. The mortality rate of patients with gram-positive infection was higher than that of patients with gram-negative infection. K. pneumoniae and S. aureus were sensitive to cefoperazone, meropenem, and levofloxacin.
Pulmonary infection is a complication post-tracheostomy in patients with spinal cord injury. Diabetes, hypoproteinemia, administration of glucocorticoids, mechanical ventilation for ≥ 6 days, length of hospital stay for ≥ 20 days were risk factors for pulmonary infection. Pulmonary infection was mainly caused by gram-negative bacteria. Timely and effective measures for managing risk factors are essential for improving the prognosis of pulmonary infection post-tracheostomy in patients with spinal cord injuries.
我们分析了接受气管切开术的脊髓损伤患者肺部感染的特征和危险因素，并提出有助于早期检测和干预的措施，以降低死亡率并改善预后。
我们回顾性收集了2018年1月1日至2022年12月31日的数据。纳入标准为：年龄18岁及以上的脊髓损伤患者，接受了气管切开术，接受机械通气超过48小时，并被诊断为肺部感染。对痰液样本进行培养和分析。
分析了101例肺部感染病例，发病率为32.17%。糖尿病（OR 2.302，95%CI 1.285 - 3.972）、低蛋白血症（OR 1.992，95%CI 1.125 - 3.101）、使用糖皮质激素（OR 2.934，95%CI 1.412 - 4.661）、美国脊髓损伤协会（ASIA）A级（OR 3.672，95%CI 1.988 - 5.046）、机械通气≥6天（OR 2.108，95%CI 1.385 - 4.751）以及住院时间≥20天（OR 2.137，95%CI 1.092 - 3.842）是气管切开术后脊髓损伤患者肺部感染的危险因素。在213株病原菌中，革兰阴性菌52株（51.48%），革兰阳性菌24株（23.76%）。肺炎克雷伯菌（15.84%）和金黄色葡萄球菌（8.91%）是最常见的病原菌。革兰阳性菌感染患者的死亡率高于革兰阴性菌感染患者。肺炎克雷伯菌和金黄色葡萄球菌对头孢哌酮、美罗培南和左氧氟沙星敏感。
肺部感染是脊髓损伤患者气管切开术后的并发症。糖尿病、低蛋白血症、使用糖皮质激素、机械通气≥6天、住院时间≥20天是肺部感染的危险因素。肺部感染主要由革兰阴性菌引起。及时有效地管理危险因素的措施对于改善脊髓损伤患者气管切开术后肺部感染的预后至关重要。
