支气管扩张感染解甘露醇罗尔斯顿菌45例临床分析  

Clinical Analysis of 45 Patients with Bronchiectasis Infection with R. mannitolilytica

作　　者：徐存来 龚恩惠 李露[1] 钱俊峰[1] 林菲菲[2] 金元虹[1] 潘炯伟[1] 曹卓[1] Xu Cunlai;Gong Enhui;Li Lu(Department of Respiratory and Critical Care,Lishui People′s Hospital,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院呼吸与危重症科,323000 [2]丽水市人民医院检验科,323000

出　　处：《医学研究杂志》2019年第9期173-177,共5页Journal of Medical Research

基　　金：浙江省丽水市科技局公益性项目(2016GYX29)

摘　　要：目的研究支气管扩张患者感染解甘露醇罗尔斯顿菌的临床表现及抗生素疗效。方法回顾性分析笔者医院解甘露醇罗尔斯顿菌所致支气管扩张伴感染住院患者45例,并根据3天疗效分为无效组17例及好转组28例。研究其临床表现及疗效,包括一般情况及基础疾病史、临床主诉及体征、影像学结果、实验室结果、细菌药敏结果、疗效及转归。结果无效组年龄、脑血管病史及有创操作率均显著高于好转组(P<0.05)。无效组白细胞计数(WBC)、中性粒细胞(NE)、C反应蛋白(CRP)、降钙素原(PCT)及血清淀粉样蛋白A(SAA)均显著高于好转组(P<0.05)。分离菌对氨曲南(100.0%)、头孢哌酮(88.9%)及美罗培南(86.7%)耐药率较高;对头孢吡肟(100.0%)、左氧氟沙星(97.8%)、头孢哌酮/舒巴坦(95.6%)及米诺环素(95.6%)敏感度较高。治疗终点(30天):好转或治愈37例(82.2%),死亡8例(17.8%)。二元Logistic回归提示脑血管病史及有创操作史与其疗效较差有关。结论脑血管病史及有创操作史可能是支气管扩张感染解甘露醇罗尔斯顿菌疗效较差的危险因素,头孢吡肟及左氧氟沙星对其可能有一定效果。Objective To study the clinical feature and anti-bacteria effect of R.mannitolilytica infection in patients with bronchiectasis.Methods Totally 45 cases of hospitalized patients with bronchiectasis and infection caused by R.mannitolilytica in Lishui Renming hospital were analyzed retrospectively,and patients were divided into 17 cases of invalid group and 28 cases in the improvement group according to the 3 days curative effect.The clinical manifestations and therapeutic effects were studied,including the general situation and the history,clinical complaints and signs,imaging results,laboratory results(leucocyte count,neutrophils count,C reactive protein,procalcitonin and serum amyloid A),bacterial drug sensitivity results,curative effects and outcomes.Results The age,history of cerebrovascular disease and invasive operation rate of invalid group were significantly higher than those of the improved group(P<0.05).The leucocyte count(WBC),neutrophils count(NE),C reactive protein(CRP),procalcitonin(PCT)and serum amyloid A(SAA)in the invalid group were significantly higher than those in the improved group(P<0.05).The isolates were resistant to aztreonan(100.0%),cefoperazone(88.9%)and meropenem(86.7%),while were sensitive to cefpime(100.0%),levofloxacin(97.8%),cefoperazone/sulbactam(95.6%)and minocycline(95.6%).At the end of treatment(30 days),37 cases(82.2%)were improved or cured,and 8 cases(17.8%)died of 30 days.And regression of binary logistic show that the history of cerebrovascular disease and the invasive operation maybe the risk factors for the poor efficacy of patients.Conclusion The history of cerebrovascular disease and the invasive operation maybe the risk factors for the poor efficacy of the R.mannitolilytica infection in patients with bronchiectasis,while cefepime and levofloxacin maybe have effects on it.

关 键 词：支气管扩张 解甘露醇罗尔斯顿菌 耐药性 血清淀粉样蛋白A 降钙素原 

分 类 号：R4[医药卫生—临床医学]