老年人耐碳青霉烯鲍曼不动杆菌支气管-肺感染的临床特点及药敏分析  

Clinical characteristics and drug sensitivity analysis of bronchial-pulmonary infection of carbapenemresistant Acinetobacter baumannii in the elderly

作　　者：邹亚宁 蒋军广[1] 崔永亮[1] 刘雪 史江[1] 黄永杰[1] 安金路 刘聪[1] Zou Yaning;Jiang Junguang;Cui Yongliang;Liu Xue;Shi Jiang;Huang Yongjie;An Jinlu;Liu Cong(Department of Elderly Respiratory Sleep Medicine,the First Affiliated Hospital of ZhengzhouUniversity,Henan Institute of Respiratory Disease,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院,河南省呼吸疾病研究所老年呼吸睡眠科,450000

出　　处：《国际呼吸杂志》2019年第10期728-733,共6页International Journal of Respiration

摘　　要：目的分析老年人耐碳青霉烯鲍曼不动杆菌支气管-肺感染临床特点、危险因素及药敏结果。方法收集我院老年支气管-肺感染临床资料共394例,根据菌株对碳青霉烯类抗生素敏感性分为耐药组(CRAB组)及敏感组(CSAB组),比较两组病例的临床特点及药敏结果等指标。结果耐药组发热率76.1%,敏感组为52.7%(χ2=8.457,P=0.004);敏感组咳嗽发生率81.8%,耐药组为68.7%(χ2=3.901,P=0.048);敏感组咳痰发生率81.8%,耐药组为68.1%(χ2=4.219,P=0.040)。耐药组Ⅰ型呼吸衰竭发生率30.3%,敏感组为16.2%(χ2=78.044,P=0.000);耐药组Ⅱ型呼吸衰竭发生率51 6%,敏感组为40.5%(χ2=32 357,P=0.000);耐药组肺性脑病发生率27.1%,敏感组为9.1%(χ2=8.306,P=0.004);耐药组心力衰竭发生率48.4%,敏感组为20.0%(χ2=15.436,P=0.000);耐药组肾脏衰竭发生率15.6%,敏感组5.5%(χ2=5.672,P=0.017)。耐药组白细胞数、中性粒细胞计数、降钙素原、C反应蛋白均高于敏感组(P值均<;0.01)。耐药组呼吸机应用比例高于敏感组(χ2=12.281,P=0.000);耐药组留置鼻饲管比例高于敏感组(χ2=34.990,P=0.000);耐药组留置尿管比例高于敏感组(χ2=38.970,P=0 0.00);耐药组深静脉置管比例高于敏感组(χ2=16.361,P=0.000);耐药组经纤维支气管镜治疗比例高于敏感组(χ2=11.380,P=0.000)。耐药组既往应用比阿培南及亚胺培南比例均高于敏感组(P<0.05)。耐药组较敏感的抗菌药物为多黏菌素(100%)、米诺环素(77.9%)、替加环素(70.4%)、阿米卡星(55.1%)。耐药组治疗有效率49%,敏感组为67.3%(χ2=6 349,P=0 012)。结论CRAB感染患者易出现发热症状,炎症指标比较高,临床治疗有效率低,易发生呼吸衰竭、肺性脑病、心力衰竭、肾脏衰竭等并发症。高危因素为呼吸机应用、纤维支气管镜治疗、鼻饲管、尿管、深静脉置管等。CRAB对多黏菌素、米诺环素、替加环素及阿米卡星敏感,推荐应用替加环素或以替加环素为主的联合�Objective To investigate the clinical characteristics,risk factors and drug susceptibility results of bronchial-pulmonary infection of carbapenem-resistant Acinetobacter baumannii in the elderly.Methods A total of 394 clinical data of elderly patients with bronchialpulmonary infection were collected.According to the sensitivity of the strain to carbapenem antibiotics,they were divided into drug-resistant group(CRAB group)and sensitive group(CSAB group).The clinical characteristics,the drug susceptibility results and other indicator of the two groups were compared.Results The fever rate of the drug-resistant group was 76.1%,while the sensitive group was 52.7%(X^2=8.457,P=0.004);The incidence of cough in the sensitive group was 81.8%,while the resistant group was 68.7%(X^2=3.901,P=0.048);The incidence of expectoration in the sensitive group was 81.8%,and that in the resistant group was 68.1%(X^2=4.219,P=0.040).The incidence of type I respiratory failure in the drug-resistant group was 30.3%,while the sensitive group was 16.2%(X^2=78.044,P=0.000).The incidence of type U respiratory failure in the drug-resistant group was 51.6%,and that in the sensitive group was 40.5%(X^2=32.357,P=0.000).The incidence of pulmonary encephalopathy in the drugresistant group was 27.1%,while 9.1%in the sensitive group(X^2=8.306,P=0.004);The incidence of heart failure in the drug-resistant group was 48.4%,and that in the sensitive group was 20.0%(X^2=15.436,p=0.000);The incidence of renal failure in the drug-resistant group was 15.6%,and that in the sensitive group was 5.5%(X^2=5.672,P=0.017).The number of white blood cells,the number of neutrophils,procalcitonin and C-reactive protein in the drug-resistant group were higher than those in the sensitive group(P<0.01).The proportion of ventilator in the drug-resistant group was higher than that in the sensitive group(X^2=12.281,P=0.000);The proportion of nasogastric tubes in the drug-resistant group was higher than that in the sensitive group(X^2=34.990,P=0.000);The proportion of indwellin

关 键 词：鲍氏不动杆菌 肺炎 老年人 危险因素 耐碳青霉烯 耐药性 

分 类 号：R56[医药卫生—呼吸系统] R446.5[医药卫生—内科学]