新疆阿克苏地区AECOPD患者下呼吸道感染病原菌分布及其危险因素  

Pathogenic bacteria distribution and risk factors of lower respiratory tract infection in patients with AECOPD in Xinjiang Akesu area

作　　者：魏新素[1] 秦勇[1] 崔海东[2] 木台力甫 喀哈尔 孙刚[5] 

机构地区：[1]新疆生产建设兵团第一师医院呼吸科,新疆阿克苏843000 [2]新疆生产建设兵团第一师阿拉尔医院内一科,新疆阿拉尔843300 [3]阿克苏地区第二人民医院肺一科,新疆阿克苏843000 [4]阿克苏市人民医院内一科,新疆阿克苏843000 [5]新疆生产建设兵团第一师医院检验科,新疆阿克苏843000

出　　处：《职业与健康》2017年第12期1647-1650,1653,共5页Occupation and Health

基　　金：师市科研项目(2015YL-12)

摘　　要：目的了解新疆阿克苏地区慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者下呼吸道感染病原体分布及耐药情况,探讨AECOPD患者下呼吸道感染相关发病因素及病机,为其治疗和预防提供依据。方法分析阿克苏地区4家医院住院确诊的AECOPD患者共2 653例,分析下呼吸道病原菌培养及药敏实验结果。根据AECOPD患者的临床特点进行分组,用卡方检验进行单因素分析筛选出发病危险因素,用logistic多因素回归分析方法,分析各个因素对多重耐药致病菌的综合影响。结果分离的病原菌大部分为革兰氏阴性菌,占69.44%(350/504),革兰阳性菌占7.54%(38/504),在革兰氏阳性菌中以肠球菌为主。革兰阳性细菌普遍对大部分抗生素均有较高程度耐药率,对糖肽类保持较高敏感性。革兰阴性细菌中,铜绿假单胞菌对青霉素类、除四代头孢外几乎对所有头孢类、磺胺类抗生素耐药率均高达90%。单因素分析结果提示下呼吸道感染多重耐药的发病与年龄(OR=2.02,P=0.04)、基础疾病(OR=0.20,P=0.00)、意识状态(OR=4.25,P=0.00)、住院时间(OR=2.23,P=0.02)、通气时间(OR=1.86,P=0.04)、通气方式(OR=7.45,P=0.02)、呼吸机及管路有微生物污染(OR=0.32,P=0.03)、有创操作有关(OR=0.26,P=0.00);与患者的性别(OR=0.67,P=0.19)、是否使用H2受体阻滞剂(OR=0.73,P=0.31)无关。以多重耐药菌为因变量(0=无,1=有),将单因素分析有统计学意义的指标输入Backward二值多元logistic回归分析。结果显示,共有3个因素进入logistic回归方程。结论革兰阳性、阴性细菌普遍对抗生素耐药。革兰阴性杆菌对绝大部分抗菌药均有不同程度耐药率。有创操作、通气时间、呼吸机管路污染是AECOPD患者下呼吸道感染多重耐药菌的主要危险因素。医疗机构应及时监测相关病原菌耐药性,加强危险因素的监测,有效控制下呼吸道感染的发生。To investigate the pathogen distribution and drug resistance of lower respiratory tract infection in patients withacute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Xinjiang Akesu area from January 2010 to December 2015, explore the risk factors and pathogenesis of lower respiratory tract infection in patients with AECOPD, and provide the basis for treatment and prevention. [Methods] 2 653 patients with AECOPD in 4 hospitals of Akesu area were collect to analyze the results of pathogen culture and drug sensitivity test. The patients with AECOPD were grouped according to their clinical characteristics. The Chi square test was applied in single factor analysis to screen the risk factors, and multifactor logistic regression was used to analyze thecombined effects of various factors on multiple drug-resistant pathogens. [Results~ Most of isolated strains were Gram negative bacteria, accounting for 69.44% （350/504）, and the Gram positive bacteria accounted for 7.54% （38/504）, which were dominated by Enterococcus. Gram positive bacteria were generally resistant to most antibiotics at a high level, and were highly sensitivity to glycopeptides.Among Gram negative bacteria, the resistance rates of Pseudomonas aeruginosa to penicillins, all cephalosporins （expect four generation cephalosporin） and sulfonamides reached 90%. The results of single factor analysis indicated that multiple drug resistance in lower respiratory tract infection was related to age （OR=2.02,P=0.04）, underlying disease （OR=0.20,P=0.00） , conscious state （OR=4.25,P=0.00）, hospital stay （OR=2.23,P=0.02）, ventilation time （OR=1.86,P=0.04）, ventilation mode （OR=7.45,P=0.02）, microorganism pollution in ventilator and pipeline （OR=0.32,P=0.03） and invasive operation （OR=0.26,P=0.00）, while was not related to gender of patients （OR=0.67,P=0.19） and use of H2 receptor blocker （OR=0.73,P=0.31 ）. When the muhidrug resistance pathogen was the dependent variable （0=No, 1=Yes）, the si

关 键 词：慢性阻塞性肺疾病 病原体 耐药 危险因素 

分 类 号：R512.62[医药卫生—内科学]