摘要
目的探讨慢性阻塞性肺部疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者下呼吸道感染病原菌的分布、耐药性及危险因素,为临床预防和治疗AECOPD下呼吸道感染提供科学依据。方法回顾性分析蚌埠市第一人民医院2016年1月—2020年12月156例AECOPD病例,根据是否发生下呼吸道感染分为研究组106例,对照组50例。针对痰培养和药敏实验的结果分析病原菌分布和耐药性;制定调查表收集病例临床资料,单因素和多因素回归分析AECOPD下呼吸道感染的危险因素。结果研究组106例病例检出120株菌,其中革兰阴性杆菌构成比为91.7%,革兰阳性菌和真菌构成比分别为7.5%和0.8%。鲍曼不动杆菌对不同种类抗生素耐药率普遍较高(34.6%~100.0%),铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌对阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和碳青霉烯类耐药率相对较低(6.1%~21.9%),4种菌对哌拉西林、环丙沙星和左氧氟沙星出现较高的耐药率(36.3%~90.0%)。单因素和多因素回顾分析结果显示住院时长(>14 d)、抗生素使用天数、合并糖尿病、合并低蛋白血症、ICU入住史是AECOPD下呼吸道感染的独立危险因素。结论AECOPD下呼吸道感染以革兰阴性杆菌为主,住院时长(>14 d)、抗生素使用天数、合并糖尿病、合并低蛋白血症、ICU入住史是AECOPD下呼吸道感染的独立危险因素。临床医生要提早预防、合理用药,保障患者的生命健康。
Objective To investigate the distribution,drug resistance and risk factors of pathogens of lower respiratory tract infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),so as providing scientific basis for clinical prevention and treatment of AECOPD lower respiratory tract infection.Methods One hundred and fifty-six cases of AECOPD in Bengbu First People′s Hospital from January 2016 to December 2020 were retrospectively analyzed.According to whether there was lower respiratory tract infection,they were divided into 106 cases in the study group and 50 cases in the control group.According to the results of sputum culture and drug sensitivity test,the distribution and drug resistance of pathogens were analyzed.Develop a questionnaire to collect the clinical data of the cases,the risk factors of lower respiratory tract infection in AECOPD were analyzed by univariate and multivariate regression.Results One hundred and twenty strains of bacteria were detected in 106 cases in the study group,of which Gram-negative bacteria accounted for 91.7%,Gram-positive bacteria and fungi accounted for 7.5%and 0.8%respectively.Acinetobacter baumannii generally had a high resistance rate to various antibiotics(34.6-100.0%),Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli had relatively low resistance rate to amikacin,Cefoperazone/sulbactam,piperacillin/tazobactam and carbapenems(6.1%-21.9%).Four strains showed high resistance rate(36.3%-90.0%)to Piperacillin,ciprofloxacin and levofloxacin.Univariate and multivariate analysis showed that length of stay(more than 14 days),duration of antibiotic use,the combination of diabetes,the combination of hypoproteinemia and ICU occupancy history were independent risk factors for AECOPD lower respiratory tract infection.Conclusions AECOPD lower respiratory tract infections are mainly Gram-negative bacilli.The length of stay(more than 14 days),the duration of antibiotic use,the combination of diabetes,the combination ofhypoalbucemia and ICU occupancy history were independent risk factors for AECOPD lower respiratory tract infection.Clinicians should prevent and use drugs reasonably in advance to ensure the life and health of patients.
作者
段友红
梁友宝
乔林爽
常滋毓
夏新红
陈尧
DUAN You-hong;LIANG You-bao;QIAO Lin-shuang;CHANG Zi-yu;XIA Xin-hong;CHEN Yao(Department of laboratory,Bengbu First People's Hospital,Anhui 233000,China)
出处
《医学动物防制》
2022年第12期1171-1175,共5页
Journal of Medical Pest Control
基金
蚌埠市科技创新指导类项目(20200301)。
关键词
AECOPD
下呼吸道感染
病原菌分布
耐药性
危险因素
分析
AECOPD
Lower respiratory tract infection
Pathogen distribution
Drug resistance
Risk factors
Analysis
