摘要
目的分析重症肺炎患者肺泡灌洗液(BALF)中鲍曼不动杆菌的检出情况及其多重耐药性。方法回顾性选取2024年1月至2024年12月在郑州市惠济区某医院、三门峡市某医院住院的重症肺炎患者326例,均收集BALF进行鲍曼不动杆菌检测,并分析耐药性及多重耐药鲍曼不动杆菌(MDRAB)检出情况,根据是否感染鲍曼不动杆菌分为鲍曼不动杆菌感染组(n=91)和鲍曼不动杆菌未感染组(n=235),对比两组临床资料,分析重症肺炎患者BALF中感染鲍曼不动杆菌的影响因素。结果326例重症肺炎患者BALF中共分离出326株病原菌,包括革兰阴性菌306株(93.87%)、革兰阳性菌20株(6.13%),其中鲍曼不动杆菌91株(27.91%,91/326),占比最高;鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率小于30%,对亚胺培南、美罗培南耐药率达85.71%、86.81%,对多黏菌素、米诺环素敏感。共检出MDRAB 20株,占鲍曼不动杆菌数的21.98%,占总菌株数的6.13%;年龄>70岁、住院天数、有创通气、使用抗菌药物种类>2种、使用碳青霉烯类抗菌药物、插管时间、感染前APACHEⅡ评分、C反应蛋白(CRP)>55 mg/L、降钙素原(PCT)为重症肺炎患者BALF中感染鲍曼不动杆菌的危险因素(P<0.05),而CD4^(+)/CD8^(+)为保护因素(P<0.05)。结论重症肺炎患者受年龄、有创通气、使用抗菌药物种类等因素影响而在BALF中鲍曼不动杆菌检出率高,且其多重耐药形势严峻,需制定针对性预防策略。
Objective To analyze the detection of Acinetobacter baumannii and its multidrug resistance in bronchoalveolar lavage fluid(BALF)from patients with severe pneumonia.Methods A total of 326 patients with severe pneumonia who were hospitalized from January 2024 to December 2024 in a hospital in Huiji District of Zhengzhou,and a hospital in Sanmenxia were retrospectively selected.BALF specimens were collected from all patients for detection of Acinetobacter baumannii,and drug resistance and the detection of multidrug-resistant Acinetobacter baumannii(MDRAB)were analyzed.According to whether they were infected with Acinetobacter baumannii,the patients were divided into an infection group(n=91)and a non-infection group(n=235).Clinical data were compared between the two groups to analyze the influencing factors of Acinetobacter baumannii infection in BALF of patients with severe pneumonia.Results A total of 326 pathogenic strains were isolated from BALF of 326 patients with severe pneumonia,including 306 Gram-negative strains(93.87%)and 20 Gram-positive strains(6.13%).Among them,91 strains(27.91%,91/326)were Acinetobacter baumannii,accounting for the highest proportion.The resistance rates of Acinetobacter baumannii to cefoperazone and sulbactam were less than 30%,while the resistance rates to imipenem and meropenem reached 85.71%and 86.81%,respectively,and the strains were susceptible to polymyxin and minocycline.A total of 20 MDRAB strains were detected,accounting for 21.98%of Acinetobacter baumannii strains and 6.13%of all isolates.Age,length of hospital stay,invasive mechanical ventilation,use of more than two types of antimicrobial agents,use of carbapenem antimicrobial agents,duration of intubation,APACHEⅡscore before infection,C-reactive protein(CRP),and procalcitonin(PCT)were risk factors for Acinetobacter baumannii infection in BALF of patients with severe pneumonia(P<0.05),whereas CD4^(+)/CD8^(+)was a protective factor(P<0.05).Conclusion The detection rate of Acinetobacter baumannii in BALF is high in patients with severe pneumonia and is influenced by factors such as age,invasive mechanical ventilation,and the number of antimicrobial agents used.The situation of multidrug resistance is severe,and targeted prevention strategies need to be developed.
作者
袁春萌
孙瑞华
刘江婷
朱朝丽
郑培明
YUAN Chunmeng;SUN Ruihua;LIU Jiangting;ZHU Chaoli;ZHENG Peiming(School of Clinical Laboratory Science and Diagnostics,Xinxiang Medical University,Xinxiang Henan 453300,China;Department of Laboratory Medicine,Huiji District People’s Hospital,Zhengzhou Henan 450000,China;Department of Laboratory Medicine,Yellow River Sanmenxia Hospital,Sanmenxia Henan 472001,China;Department of Laboratory Medicine,Yuzhou Central Hospital,Yuzhou Henan 461670,China;Department of Laboratory Medicine,Henan Provincial People’s Hospital,Zhengzhou Henan 450000,China)
出处
《临床研究》
2025年第12期159-163,共5页
Clinical Research
关键词
重症肺炎
肺泡灌洗液
鲍曼不动杆菌
多重耐药性
Severe pneumonia
Bronchoalveolar lavage fluid
Acinetobacter baumannii
Multidrug resistance
