重度慢性阻塞性肺疾病患者多药耐药革兰阴性菌下呼吸道感染的危险因素分析  

Risk factors for lower respiratory tract infections caused by multidrug-resistant gram-negative bacteria in patients with severe chronic obstructive pulmonary disease

作　　者：吴文汉 孙爱华[2] 袁满春 张秋[1] 楼翔[1] 

机构地区：[1]浙江大学附属第一医院嵊州分院检验科,浙江嵊州312400 [2]杭州医学院,浙江杭州310053

出　　处：《中华医院感染学杂志》2016年第20期4635-4637,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(81271893);浙江省卫生高层次创新人才培养工程项目([2012]241)

摘　　要：目的了解重度慢性阻塞性肺疾病(COPD)患者革兰阴性多药耐药菌(MDRB)下呼吸道感染的易感因素、病原菌分布,为预防和控制多药耐药菌株产生提供依据。方法选取2013年1月-2015年11月医院呼吸内科277例革兰阴性下呼吸道感染的重度慢性阻塞性肺疾病住院患者,分析MDRB感染率、易感因素和病原菌分布。结果重度COPD患者MDRB感染率为28.52%,易感因素包括医院获得性感染、合并糖尿病、低白蛋白血症、侵袭性操作、第三代头孢菌素、使用氟喹诺酮类药物、联合应用抗菌药物≥3d;79株革兰阴性多药耐药菌主要为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌。结论应加强对重度慢性阻塞性肺疾病患者革兰阴性多药耐药菌下呼吸道感染病原菌的监测与控制,根据药敏结果合理选用抗菌药物,以减少耐药菌株产生。OBJECTIVE To understand the predisposing factors for lower respiratory tract mtections caused by mut- tidrug-resistant gram-negative bacteria （MDRB） in patients with severe chronic obstructive pulmonary disease （COPD） and analyze the distribution of pathogens so as to provide guidance for prevention and control of emer- gence of the multidrug-resistant strains. METHODS A total of 277 severe COPD patients with gram-negative bacte- ria lower respiratory tract infections who were hospitalized from Jan 2013 to Nov 2015 were enrolled in the study. The incidence of MDRB infection, predisposing factors, and distribution of pathogens were observed. RESULTS The incidence of MDRB infection was 28.52 % in the patients with severe COPD. The predisposing factors includ- ed the hospital-acquired infection, complication with diabetic mellitus, hypoalbuminemia, invasive operations, third generation cephalosporins, use of fluoroquinolones, and combined use of antibiotics no less than 3 days. The Acinetobacter baumannii , Pseudomonas aeruginosa , Klebsiella pneumoniae , and Escherichia coli were dominant among the 79 strains of multidrug-resistant gram-negative bacteria. CONCLUSION It is necessary to strengthen the surveillance and control of the pathogens causing the lower respiratory tract infections in the patients with severe COPD and reasonably use antibiotics based on the results of the drug susceptibility testing sO as to prevent the e- mergence of the drug-resistant strains.

关 键 词：慢性阻塞性肺疾病 革兰阴性杆菌 下呼吸道感染 多药耐药 抗菌药物 

分 类 号：R563[医药卫生—呼吸系统]