摘要
目的检测慢性阻塞性肺疾病急性加重期(AECOPD)患者肺部感染病原菌的分布和耐药性,并对其感染危险因素进行分析。方法选择2017年1月至2019年1月本院收治的AECOPD肺部感染患者391例,采集痰液标本进行病原学检查及其耐药性检测。统计患者的性别、年龄、住院时间、机械通气时间以及意识功能障碍等资料,进行肺部感染单因素分析。结果391例AECOPD肺部感染患者共培养出病原菌455株,其中革兰阴性(G)菌311株,占68.35%;革兰阳性(G+)菌115株,占25.27%;真菌29株,占6,38%。G菌中的铜绿假单胞菌对复方新诺明耐药率为99.01%,阿米卡星耐药率为9,90%;鲍曼不动杆菌对阿米卡星的耐药率为12.99%;肺炎克雷伯菌对阿米卡星耐药率为10.94%,对亚胺培南和美罗培南均敏感。G+菌中的金黄色葡萄球菌、肺炎链球菌、表皮葡萄球菌对氨苄西林、克林霉素.左氧氟沙星的耐药率为76.09%~100.00%,对万古霉素、替考拉宁均敏感。单因素分析显示,年龄.住院时间、机械通气时间以及意识功能障碍是AECOPD患者肺部感染发生的危险因素(P<0.05)。结论AECOPD患者肺部感染病原菌菌谱广泛且具有一定的耐药性,肺部感染的发生与年龄、住院时间、机械通气时间以及意识功能障碍等因素有关。开展病原学及其耐药性检测,控制相关感染因素,对于AECOPD患者肺部感染的预防和治疗具有重要意义。
Objective To determine the distribution and drug resistance of pathogens in patients with acute exacerba-tion of chronic obstructive pulmonary disease(AECOPD)and a pulmonary infection and to analyze the risk factors for in-fections.Methods Subjects were 391 patients with AECOPD and a pulmonary infection seen at this Hospital from Jan-uary 2017 to January 2019.Sputum samples were collected to test for pathogens,and a drug resistance test was conduc-ted.A univariate analysis of factors for developed of a pulmonary infection was performed using the patient's sex,age,duration of hospitalization,duration of mechanical ventilation,and disturbance of consciousness.Results Four hundred and fifty-five strains of pathogens were cultured from 391 patients with AECOPD and a pulmonary infection.Of those strains,311(68.35%)were strains of Gram-negative bacteria,115(25.27%)were strains of Gram positive bacteria,and 29(6.38%)were strains of fungi.The Gram:negative bacterium Pseudomonas aeruginosa was resistant to trime-thoprim-sulfamethoxazole at a rate of 99.01%and to amikacin at a rate of 9.90%.Acinelobacter baumannii was resistant to amikacin at a rate of 12.99%.Klebsiella pneumoniae was resistant to amikacin at a rate of 10.94%but sensitive to both imipenem and meropenem.The Gram positive bacteria Sta phylococcus aureus,Stre ptococcus pneumoniae,and S.epidermidis were resistant to ampicilin,clindamyein,and levofloxacin at a rate ranging from 76.09%to 100%and sensi-tive to both vancomycin and teicoplanin.Univariate analysis indicated that,age,duration of hospitalization,duration of mechanical ventilation,and disturbance of consciousness were risk factors for development of a pulmonary infection in pa-tients with AECOPD(P<0.05).Conclusion A broad spectrum of pathogens caused a pulmonary infection in patients with AECOPD,and those pathogens had a certain degree of drug resistance.The development of a pulmonary infection was related to age,duration of hospitalization,duration of mechanical ventilation,and disturbance of consciousness.Eti-ology,a drug resistance test,and control of factors related to infection are crucial to the prevention and treatment of a pulmonary infection in patients with AECOPD.
作者
张丽
范忠杰
周凡
ZHANG Li;FAN Zhong-jie;ZHOU Fan(Respiratory Medicine,Wuhan Red Cross Hospital,Wuhan,China 430015)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第12期1456-1459,共4页
Journal of Pathogen Biology
关键词
AECOPD
肺部感染
病原菌分布
耐药性
危险因素
AECOPD
pulmonary infection
distribution of pathogens
drug resistance
risk factors
