摘要
目的分析老年人耐碳青霉烯鲍曼不动杆菌支气管-肺感染临床特点、危险因素及药敏结果。方法收集我院老年支气管-肺感染临床资料共394例,根据菌株对碳青霉烯类抗生素敏感性分为耐药组(CRAB组)及敏感组(CSAB组),比较两组病例的临床特点及药敏结果等指标。结果耐药组发热率76.1%,敏感组为52.7%(χ^(2)=8.457,P=0.004);敏感组咳嗽发生率81.8%,耐药组为68.7%(χ^(2)=3.901,P=0.048);敏感组咳痰发生率81.8%,耐药组为68.1%(χ^(2)=4.219,P=0.040)。耐药组Ⅰ型呼吸衰竭发生率30.3%,敏感组为16.2%(χ^(2)=78.044,P=0.000);耐药组Ⅱ型呼吸衰竭发生率516%,敏感组为40.5%(χ^(2)=32357,P=0.000);耐药组肺性脑病发生率27.1%,敏感组为9.1%(χ^(2)=8.306,P=0.004);耐药组心力衰竭发生率48.4%,敏感组为20.0%(χ^(2)=15.436,P=0.000);耐药组肾脏衰竭发生率15.6%,敏感组5.5%(χ^(2)=5.672,P=0.017)。耐药组白细胞数、中性粒细胞计数、降钙素原、C反应蛋白均高于敏感组(P值均<;0.01)。耐药组呼吸机应用比例高于敏感组(χ^(2)=12.281,P=0.000);耐药组留置鼻饲管比例高于敏感组(χ^(2)=34.990,P=0.000);耐药组留置尿管比例高于敏感组(χ^(2)=38.970,P=00.00);耐药组深静脉置管比例高于敏感组(χ^(2)=16.361,P=0.000);耐药组经纤维支气管镜治疗比例高于敏感组(χ^(2)=11.380,P=0.000)。耐药组既往应用比阿培南及亚胺培南比例均高于敏感组(P<0.05)。耐药组较敏感的抗菌药物为多黏菌素(100%)、米诺环素(77.9%)、替加环素(70.4%)、阿米卡星(55.1%)。耐药组治疗有效率49%,敏感组为67.3%(χ^(2)=6349,P=0012)。结论CRAB感染患者易出现发热症状,炎症指标比较高,临床治疗有效率低,易发生呼吸衰竭、肺性脑病、心力衰竭、肾脏衰竭等并发症。高危因素为呼吸机应用、纤维支气管镜治疗、鼻饲管、尿管、深静脉置管等。CRAB对多黏菌素、米诺环素、替加环素及阿米卡星敏感,推荐应用替加环素或以替加环素为主的联合抗感染治疗。
Objective To investigate the clinical characteristics,risk factors and drug susceptibility results of bronchial-pulmonary infection of carbapenem-resistant Acinetobacter baumannii in the elderly.Methods A total of 394 clinical data of elderly patients with bronchialpulmonary infection were collected.According to the sensitivity of the strain to carbapenem antibiotics,they were divided into drug-resistant group(CRAB group)and sensitive group(CSAB group).The clinical characteristics,the drug susceptibility results and other indicator of the two groups were compared.Results The fever rate of the drug-resistant group was 76.1%,while the sensitive group was 52.7%(χ^(2)=8.457,P=0.004);The incidence of cough in the sensitive group was 81.8%,while the resistant group was 68.7%(χ^(2)=3.901,P=0.048);The incidence of expectoration in the sensitive group was 81.8%,and that in the resistant group was 68.1%(χ^(2)=4.219,P=0.040).The incidence of type I respiratory failure in the drug-resistant group was 30.3%,while the sensitive group was 16.2%(χ^(2)=78.044,P=0.000).The incidence of type U respiratory failure in the drug-resistant group was 51.6%,and that in the sensitive group was 40.5%(χ^(2)=32.357,P=0.000).The incidence of pulmonary encephalopathy in the drugresistant group was 27.1%,while 9.1%in the sensitive group(χ^(2)=8.306,P=0.004);The incidence of heart failure in the drug-resistant group was 48.4%,and that in the sensitive group was 20.0%(χ^(2)=15.436,p=0.000);The incidence of renal failure in the drug-resistant group was 15.6%,and that in the sensitive group was 5.5%(χ^(2)=5.672,P=0.017).The number of white blood cells,the number of neutrophils,procalcitonin and C-reactive protein in the drug-resistant group were higher than those in the sensitive group(P<0.01).The proportion of ventilator in the drug-resistant group was higher than that in the sensitive group(χ^(2)=12.281,P=0.000);The proportion of nasogastric tubes in the drug-resistant group was higher than that in the sensitive group(χ^(2)=34.990,P=0.000);The proportion of indwelling catheter in the drug-resistant group was higher than that in the sensitive group(χ^(2)=38.970,P=0.000);The proportion of deep vein catheterization in the drug-resistant group was higher than that in the sensitive group(χ^(2)=16.361,P=0.000);The proportion of patients treated with fiberoptic bronchoscopy was higher than that of the sensitive group(χ^(2)=11.380,P=0.000).The ratio of biapenem and imipenem used in the drug-resistant group was higher than that in the sensitive group(P<0.05).The sensitive antibiotics in the drug-resistant group were polymyxin(100%),minocycline(77.9%),tigecycline(70.4%),and amikacin(55.1%).The effective rate of treatment in the drug-resistant group was 49%,and that in the sensitive group was 67.3%(χ^(2)=6.349,P=0.012).Conclusions Patients with CRAB infection are prone to fever,high inflammatory index,low clinical efficacy and complications such as respiratory failure,pulmonary encephalopathy,heart failure and kidney failure.The risk factors are ventilator application,fiberoptic bronchoscopy,nasal feeding tube,urinary catheter,and deep vein catheterization.CRAB is sensitive to polymyxin,minocycline,tigecycline and amikacin,and tigecycline or tigecycline-based combination anti-infective therapy is recommended.
作者
邹亚宁
蒋军广
崔永亮
刘雪
史江
黄永杰
安金路
刘聪
Zou Yaning;Jiang Junguang;Cui Yongliang;Liu Xue;Shi Jiang;Huang Yongjie;An Jinlu;Liu Cong(Department of Elderly Respiratory Sleep Medicine,the First Affiliated Hospital of ZhengzhouUniversity,Henan Institute of Respiratory Disease,Zhengzhou 450000,China)
出处
《国际呼吸杂志》
2019年第10期728-733,共6页
International Journal of Respiration
基金
国家卫生和计划生育委员会国家临床重点专科建设项目[国卫办医函(2013)544号]
关键词
鲍氏不动杆菌
肺炎
老年人
危险因素
耐碳青霉烯
耐药性
Acinetobacter baumannii
Pneumonia
Aged
Risk factors
Carbapenem-resistant
Drug resistance
