重症肺炎病原菌耐药性及T细胞亚群变化  

Drug resistance of pathogens isolated from patients with severe pneumonia and changes of T cell subsets

作　　者：吕颖 张一杰 吴珺 徐蕤[4] 孟德志 LYU Ying;ZHANG Yi-jie;WU Jun;XU Rui;MENG De-zhi(Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China;不详)

机构地区：[1]首都医科大学附属北京世纪坛医院神经与精神科,北京100038 [2]首都医科大学附属北京世纪坛医院急诊科,北京100038 [3]首都医科大学附属北京世纪坛医院全科医学科,北京100038 [4]北京丰台医院重症医学科,北京100070

出　　处：《中华医院感染学杂志》2020年第20期3085-3089,共5页Chinese Journal of Nosocomiology

基　　金：艾滋病研究北京市重点实验室基金资助项目(BZ0089)。

摘　　要：目的探究重症肺炎(SP)患者病原菌耐药性及其T细胞亚群变化特点。方法选取2014年6月-2018年6月于北京丰台医院住院治疗的SP患者102例,调查患者一般临床资料,总结患者临床特征;收集患者下呼吸道样本进行病原菌培养,分析其分布特点和耐药性;采用流式细胞仪检测患者外周血T细胞亚群的含量,观察不同年龄段SP患者T细胞亚群的变化特点。结果入组SP患者共收集下呼吸道样本871份,细菌培养阳性率为32.15%(280/871),以革兰阴性菌为主(85.71%)。鲍氏不动杆菌仅对磺胺甲噁唑/甲氧苄啶相对敏感,肺炎克雷伯菌对阿米卡星、美罗培南及亚胺培南的耐药率较低,铜绿假单胞菌对阿米卡星和妥布霉素耐药率<20%,嗜麦芽寡养单胞菌对磺胺甲噁唑/甲氧苄啶敏感,对氨苄西林/舒巴坦、哌拉西林/他唑巴坦及环丙沙星相对敏感,大肠埃希菌对阿米卡星、美洛培南及亚胺培南敏感。老年组CD3^+、CD3^+CD4^+及CD3^+CD8^+水平均低于青年组和中年组(P<0.05)。结论SP患者以老年男性为主,革兰阴性菌感染比较常见,且对多数临床常用抗菌药物具有较高的耐药率,需要仔细分析患者具体情况,结合动态耐药信息和自身免疫状态,合理选用抗菌药物,并给予免疫增强治疗。OBJECTIVE To explore the drug resistance of pathogens isolated from the patients with severe pneumonia(SP)and observe the characteristics of change of T cell subsets.METHODS A total of 102SP patients who were treated in Beijing Fengtai Hospital from Jun.2014to Jun.2018were enrolled in the study,the baseline clinical data of the patients were investigated,the clinical characteristics of the patients were summarized.The lower respiratory tract specimens were collected for culture of pathogens,the distribution and drug resistance of the pathogens were observed.The contents of peripheral blood T cell subsets were detected by using flow cytometry,and the characteristics of change of T cell subsets were observed and compared among the SP patients in different age groups.RESULTS Totally 871lower respiratory tract specimens were collected from the enrolled SP patients,the positive rate of bacterial culture was 32.15%;gram-negative bacteria(85.71%)were dominant among the isolated pathogens.Acinetobacter baumannii strains were relatively sensitive to compound sulfamethoxazole,the drug resistance rates of Klebsiella pneumoniae strains to amikacin,meropenem and imipenem were relatively low;the drug resistance rates of Pseudomonas aeruginosastrains to amikacin and tobramycin were less than 20%.Stenotrophomonas maltophilia strains were sensitive to compound sulfamethoxazole and were relatively sensitive to ampicillin-sulbactam,piperacillin-tazobactam and ciprofloxacin.Escherichia coli strains were sensitive to amikacin,meropenem and imipenem.The levels of CD3^+,CD3^+CD4^+and CD3^+CD8^+of the elderly group were significently lower than those of the young group and the middle-age group(P<0.05).CONCLUSION The elderly male patients are dominant among the SP patients,the gram-negative bacteria are the predominant pathogens causing the infection and are highly resistant to most of the commonly used antibiotics.It is necessary to carefully analyze the specific condition of the patients,reasonably use antibiotics based on the dynamic

关 键 词：重症肺炎 临床特点 病原菌分布 耐药性 T细胞亚群 

分 类 号：R563.1[医药卫生—呼吸系统]