Risk factors and clinical characteristics of macrolide resistance Moraxella catarrhalis pneumonia
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摘要:
目的 了解大环内酯耐药卡他莫拉菌（MRMC）肺炎患者的临床特征，探讨其患病的危险因素。 方法 对2013年1月至2022年1月的32例MRMC肺炎患者和114例大环内酯敏感卡他莫拉菌（MSMC）肺炎患者信息进行回顾分析。 结果 卡他莫拉菌肺炎患者以男性为主（71.92%），≥65岁者居多（67.12%），冬春季高发（64.38%）。 多因素logistic回归分析结果显示，女性（OR=2.77, 95%CI: 1.18～6.47）和陈旧性肺结核病史（OR=5.95, 95%CI: 1.31～31.57）是感染MRMC肺炎的独立危险因素。 MRMC组患者发热（OR=2.87, 95%CI: 1.09～7.46）、C反应蛋白升高（OR=2.65, 95%CI: 1.12～6.63）、支气管炎（OR=4.00, 95%CI: 1.54～11.52）和肺气肿影像学表现（OR=5.73, 95%CI: 1.94～19.56）的比例显著高于MSMC组。 结论 女性和陈旧性肺结核病史是感染MRMC肺炎的独立危险因素，且MRMC组患者的症状、炎症和影像学表现更严重，应关注其临床诊治。 Abstract:Objective To explore the clinical characteristics and risk factors of macrolide resistance Moraxella catarrhalis (MRMC) pneumonia. Methods From January 2013 to January 2022, the information of 32 patients with MRMC pneumonia and 114 patients with macrolides sensitive Moraxella catarrhalis (MSMC) pneumonia were retrospectively analyzed. Results The patients with Moraxella catarrhalis pneumonia were mainly men (71.92%) and aged ≥65 years (67.12%). The incidence rate was high in winter and spring (64.38%). Multivariate logistic regression analysis showed that being woman (OR=2.77, 95% CI: 1.18–6.47) and the history of tuberculosis (OR=5.95, 95% CI: 1.31–31.57) were independent risk factors for MRMC pneumonia. The percentage of patients with fever (OR=2.87, 95% CI: 1.09–7.46), abnormal C-reactive protein (OR=2.65, 95% CI: 1.12–6.63), bronchitis (OR=4.00, 95% CI: 1.54–11.52), and emphysema (OR=5.73, 95% CI: 1.94–19.56) increased significantly in the MRMC group compared with the MSMC group. Conclusion Being woman and the history of tuberculosis were independent risk factors for MRMC pneumonia, and patients in the MRMC group had more severe symptoms, inflammation and pulmonary imaging manifestations, suggesting that attention should be paid to the clinical diagnosis and treatment of MRMC pneumonia. -
Key words:
- Moraxella catarrhalis /
- Macrolides /
- Drug resistance /
- Risk factor /
- Clinical characteristics
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表 1 146例卡他莫拉菌肺炎患者的基本信息
Table 1. Basic information of 146 patients with Moraxella catarrhalis pneumonia
变量 例数 构成比（%） 性别 男性 105 71.92 女性 41 28.08 年龄组（岁） ＜65 48 32.88 ≥65 98 67.12 吸烟 是 52 35.62 否 94 64.38 饮酒 是 20 13.70 否 126 86.30 季节 冬春 94 64.38 夏秋 52 35.62 标本类型 痰液 133 91.10 支气管肺泡灌洗液 13 8.90 
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表 2 大环内酯耐药卡他莫拉菌肺炎患者危险因素的单因素分析
Table 2. Univariate analysis on risk factors in patients with macrolides resistant Moraxella catarrhalis pneumonia
变量 大环内酯耐药卡他莫拉菌组（n=32） 大环内酯敏感卡他莫拉菌组（n=114） χ 2值 P值 病例数（例） 构成比（%） 病例数（例） 构成比（%） 性别（女） 15 46.88 26 22.81 6.024 0.014 a 吸烟（是） 6 18.75 46 40.35 4.186 0.041 a 饮酒（是） 2 6.25 18 15.79 0.246 b 基础疾病 慢性阻塞性肺疾病 11 34.38 30 26.32 0.454 0.500 陈旧性肺结核 5 15.63 3 2.63 0.013 ab 高血压 16 50.00 68 59.65 0.598 0.439 糖尿病 8 25.00 21 18.42 0.329 0.566 脑卒中后遗症 12 37.50 41 35.96 ＜0.001 1.000 冠状动脉粥样硬化性心脏病 12 37.50 36 31.58 0.174 0.677 注：a. P<0.100，纳入多因素logistic回归分析；b. 采用Fisher确切概率法
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表 3 大环内酯耐药卡他莫拉菌肺炎患者危险因素的logistic回归分析
Table 3. Logistic regression analysis on risk factors in patients with macrolides resistant Moraxella catarrhalis pneumonia
变量 变量赋值 单因素logistic回归 多因素logistic回归 OR值（95%CI） OR值（95%CI）a OR值（95%CI）b 性别 男=0，女=1 2.99（1.31～6.83）c – 2.77 （1.18～6.47）c 吸烟 否=0，是=1 0.34（0.12～0.85）c 0.55 （0.17～1.60） – 陈旧性肺结核 否=0，是=1 6.85（1.58～35.10）c 9.65 （1.97～56.53）c 5.95 （1.31～31.57）c 注：a. 调整年龄和性别因素；b. 逐步回归法筛选后，纳入性别和陈旧性肺结核因素后的多因素logistic回归分析结果；c. OR值对应的P<0.050，差异有统计学意义；–. 未纳入多因素logistic回归分析
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表 4 大环内酯耐药卡他莫拉菌肺炎患者临床特征的单因素分析
Table 4. Univariate analysis on clinical characteristics of patients with macrolides resistant Moraxella catarrhalis pneumonia
变量 大环内酯耐药卡他莫拉菌组（n=32） 大环内酯敏感卡他莫拉菌组（n=114） w或χ2值 P值 病例数或
中位数构成比（%）或
Q1～Q3病例数或
中位数构成比（%）或
Q1～Q3临床表现a 咳嗽 22 68.75 81 71.05 0.001 0.974 咳痰 18 56.25 68 59.65 0.020 0.887 发热 10 31.25 18 15.79 2.920 0.087c 咯血 3 9.38 2 1.75 0.070 ce 喘息气促 13 40.63 42 36.84 0.034 0.854 感染指标（n=137）a 30 107 白细胞计数（＞9.5×109 /L） 12 40.00 30 28.04 1.065 0.302 C反应蛋白（＞0.6 mg/mL） 20 66.67 44 41.12 5.159 0.023 c 降钙素原（＞0.5 ng/mL） 3 10.00 16 14.95 0.765 e 影像学表现（n=122）a 29 93 支气管炎 19 65.52 39 41.94 4.029 0.045 c 肺气肿 13 44.83 23 24.73 3.380 0.066 c 肺结节 9 31.03 26 27.96 0.007 0.932 胸腔积液 9 31.03 31 33.33 ＜0.001 0.997 肺间质性病变 8 27.59 18 19.35 0.470 0.493 疾病危险程度 住院天数（d）b 11 6～18 12 9～22 2171.5 0.100 抗生素使用种类（种）b 2 1～4 1 1～2 1391.5 0.034 c 抗生素使用天数（d）b 6 3～8 3 3～6 1544.0 0.166 是否入住ICU（是）a 10 31.25 31 27.19 0.052 0.819 是否气管插管（是）a 4 12.50 7 6.14 0.258 e CURB-65评分（分）b 1 0～2 1 1～2 1757 0.742 qSOFA评分（分）b 0 0～1 0 0～1 1655.5 0.316 是否住院期间死亡（是）a 0 0.00 3 2.63 1.000e 注：a.为计数资料，分析采用病例数和构成比；b.为计量资料，分析采用中位数和分位数；c. P < 0.100，纳入多因素logistic回归分析；
e. 采用Fisher确切概率法；Q1为25%分位数，Q3为75%分位数；CURB-65评分为英国胸科协会改良肺炎评分；qSOFA评分为快速序贯器官衰竭评分
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表 5 大环内酯耐药卡他莫拉菌肺炎患者临床特征的logistic回归分析
Table 5. Logistic regression analysis on clinical characteristics of patients with macrolides resistant Moraxella catarrhalis pneumonia
变量 变量赋值 单因素logistic回归 多因素logistic回归 OR值 （95%CI） OR （95%CI） a 发热 否=0，是=1 2.42 （0.96～5.92） 2.87 （1.09～7.46） b 咯血 否=0，是=1 5.79 （0.92～45.55） 5.91 （0.87～48.86） C反应蛋白 ≤0.6 mg/mL=0，＞0.6 mg/mL=1 2.86 （1.25～6.94） b 2.65 （1.12～6.63） b 支气管炎 否=0，是=1 2.63 （1.12～6.48） b 4.00 （1.54～11.52） b 肺气肿 否=0，是=1 2.47 （1.03～5.93） b 5.73 （1.94～19.56） b 抗生素使用种类 ≤3种=0，＞3种=1 2.80 （1.05～7.20） b 2.57 （0.91～7.04） 注：a.调整年龄和性别因素；b. OR值对应的P<0.050，差异有统计学意义
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