摘要
目的研究慢性呼吸道疾病并发社区获得性下呼吸道细菌感染住院患者的病原菌分布。方法回顾性分析2001～2005年在北京大学第三医院呼吸病房住院的212例社区获得性下呼吸道细菌感染患者的临床资料、痰培养及药敏结果，患者均具有慢性呼吸道基础疾病。结果临床分离病原菌229株，革兰阴性杆菌为主。慢性阻塞性肺疾病急性加重期患者感染的病原菌中革兰阴性杆菌占73．9％，铜绿假单胞菌和肺炎克雷伯菌最常见，分别为18．2％和13．6％；革兰阳性球菌占23-8％，其中金黄色葡萄球菌10．2％，肺炎链球菌9．1％。支气管扩张症患者感染革兰阴性杆菌占86．2％，前3位分别为铜绿假单胞菌（27．5％）、副流感嗜血杆菌（13．7％）和流感嗜血杆菌（11.8％）。Logistic回归分析发现：感染铜绿假单胞菌的危险因素为患有支气管扩张症（OR=5．590，95％CI 2．792～11．192）；感染鲍曼不动杆菌的危险因素为前1个月内使用制酸剂（OR=9．652，95％CI 2．636～35．339）和低蛋白血症（OR=2．679，95％CI 1．108～6．476）；感染肠杆菌科细菌（包括肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌）的危险因素为前1个月内使用抗菌药物（OR=4．236，95％CI 1．982～9．057），患有肾脏疾病（OR=4．305，95％CI 1．090-17．008）和糖尿病（OR=2．836，95％CI 1．339—6．009）。结论患有慢性呼吸道疾病患者并发社区获得性下呼吸道感染时的病原菌以革兰阴性杆菌为主，根据基础疾病、病情严重程度和用药史的不同而变化，对病原菌的正确判断有助于制定合理的经验性抗感染方案。
Objective To explore the bacteria distribution among community acquired lower respiratory tract infection （LRTI） inpatients with underlying chronic respiratory tract diseases. Methods The clinical data, sputum culture and drug susceptibility results of 212 community acquired LRTI patients with various underlying chronic respiratory tract diseases who were hospitalized during the period of 2001 to 2005 were analyzed retrospectively. Results A total of 229 strains of pathogens were detected, with the majority being gram negative bacteria. In pathogens of acute exacerbation of chronic obstructive pulmonary disease, gram negative bacteria occupied 73.9%, with Pseudomonas aeruginosa and Klebsiella pneumoniae as the most common pathogens （18.2% and 13.6%, respectively）. Gram positive bacteria occupied 23.8%, mainly Staphylococcus aureus （ 10.2% ） and Streptococcus pneumoniae （9.1% ）. In patients with bronchiectasis exacerbated due to bacterial infectiong6.2% were caused by gram negative bacteria with Pseudomonas aeruginosa （27.5%）, Haemophilus parainfluertzae （13.7%）,and Haemophilus influertzae （11.8%） as the most frequent pathogeus. Bronchiectasis was the major risk factor for Pseudomonas aeruginosa infection （ OR = 5.590,95% CI 2.792-11.192） .The risk factors for Acinetobaaer baumanii infection were antacid therapy within 1 month （ OR = 9.652,95% CI 2.636-35.339） and hypoproteinemia （ OR = 2.679, 95% CI 1.108-6.476）. For enterobaeters infections, including Klebsiella pneurmoniae , Enterobaeter cloacae and Escherichia coil, the risk factors were antibiotic therapy within 1 month （ OR = 4.236,95 % CI 1.982-9.057）, renal disease （ OR = 4.305,95 % CI 1.090-17.008） and diabetes mellitus （ OR = 2.836,95 % CI 1.339-6.009）. Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases. The pathogens were influenced by categories and severity of underlying diseases as well as medical intervention.
出处
《中国呼吸与危重监护杂志》
CAS
2007年第2期82-87,共6页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
社区获得性下呼吸道感染
慢性阻塞性肺疾病
支气管扩张症
病原菌
危险因素
回归分析
Community acquired lower respiratory tract infection
Chronic obstructive pulmonary disease
Bronchiectasis
Pathogen
Risk factors
Regression analysis
