肺结核患者住院期间获得性肺部多药耐药菌感染及其影响因素  

Analysis of current status and influencing factors of acquired pulmonary multi-drug resistant organism infection in patients with pulmonary tuberculosis during hospitalization

作　　者：牛俊梅[1] 李振魁[1] 崔俊伟[1] 张边防 王永亮[1] NIU Jun-mei;LI Zhen-kui;CUI Jun-wei;ZHANG Bian-fang;WANG Yong-liang(The First Affiliated Hospital of Xinxiang Medical College,Xinxiang,Henan453100,Henan)

机构地区：[1]新乡医学院第一附属医院结核科,河南新乡453100

出　　处：《中华医院感染学杂志》2020年第12期1822-1825,共4页Chinese Journal of Nosocomiology

基　　金：国家卫生健康委员会基金资助项目(2018ZX10302302)。

摘　　要：目的分析肺结核患者住院期间获得性肺部多药耐药菌(Multi-drug resistant organism,MDRO)感染现状与影响因素。方法回顾性分析新乡医学院第一附属医院2016年1月-2019年1月肺结核合并医院获得性肺炎(Hospital acquired pneumonia,HAP)患者的病例资料,共计568例。分析患者年龄、合并慢性肺部疾病、合并脑血管疾病、抗菌药物应用种类、深静脉置管、气管插管、机械通气、吸烟史等因素,归纳肺结核患者住院期间获得性肺部MDRO感染的影响因素。结果 568例肺结核HAP患者共检出MDRO 227株,检出率为39.96%(227/568);肺结核HAP感染MDRO患者耐药性最高的抗结核药物为异烟肼,其次为利福平、氧氟沙星、链霉素;肺结核HAP患者年龄、合并慢性肺部疾病、合并脑血管疾病、抗菌药物应用种类、深静脉置管、气管插管、机械通气、吸烟史,差异有统计学意义(P<0.05);经Logistic回归分析,合并慢性肺部疾病、合并脑血管疾病、抗菌药物应用种类、深静脉置管、机械通气、吸烟史为肺结核HAP患者MDRO感染的影响因素(P<0.05)。结论肺结核患者住院期间获得性肺部MDRO感染较多,耐药率高,应针对病原菌特点及感染的影响因素,行合理有效的预防措施与治疗方案,并切实加强医院感染监测力度。OBJECTIVE To analyze the status and influencing factors of acquired pulonary multi-drug resistant organism(MDRO) infection of pulmonary tuberculosis patients during hospitalization. METHODS A retrospective analysis of the case data of 568 patients with pulmonary tuberculosis and hospital acquired pneumonia(HAP) in the First Affiliated Hospital of Xinxiang Medical College from Jan. 2016 to Jan. 2019 was conducted. Factors such as patient age, combined chronic lung diseases, combined cerebrovascular diseases, types of antimicrobial application, deep venous catheterization, tracheal intubation, mechanical ventilation, smoking history, etc. were analyzed, and the influencing factors of acquired pulmonary MDRO infection of pulmonary tuberculosis patients during hospitalization were summarized. RESULTS A total of 227 strains of MDRO were detected in 568 HAP patients with pulmonary tuberculosis, with a detection rate of 39.96%(227/568). Among MDRO strains of tuberculosis and HAP infection patients, the anti-tuberculosis drug with the highest drug resistance was isoniazid, followed by rifampicin and oxyfluoride Saccharin and streptomycin. The differences of age, combination of chronic lung diseases, combination of cerebrovascular diseases, types of antibacterial drugs, deep vein catheterization, tracheal intubation, mechanical ventilation, smoking history between the two groups of tuberculosis HAP patients were significant(P<0.05). Logistic regression analysis showed that combined chronic lung diseases, combined cerebrovascular diseases, types of antimicrobial application, deep vein catheterization, mechanical ventilation, and smoking history were the influencing factors of MDRO in patients with tuberculosis HAP(P<0.05). CONCLUSIONS There are many acquired pulmonary MDRO infections in tuberculosis patients during hospitalization, and the drug resistance rate is high. Reasonable and effective preventive measures and treatment programs should be implemented according to the characteristics of pathogens and the influencing

关 键 词：肺结核 医院获得性肺炎 多药耐药菌感染 住院期间 易感因素 

分 类 号：R563.1[医药卫生—呼吸系统]