COPD患者肺部感染的病原学及多药耐药铜绿假单胞菌感染危险因素  

Etiological characteristics of pulmonary infection in COPD patients and risk factors for multidrug-resistant Pseudomonas aeruginosainfection

作　　者：余来顺 谢守宁[2] 妥亚军[1] 张方[1] 刘佳薇 YU Lai-shun;XIE Shou-ning;TUO Ya-jun;ZHANG Fang;LIU Jia-wei(Qinghai Provincial People′s Hospital,Xining,Qinghai 810000,China)

机构地区：[1]青海省人民医院呼吸与危重症医学科,青海西宁810000 [2]青海省人民医院骨科,青海西宁810000 [3]青海省人民医院控制感染科,青海西宁810000

出　　处：《中华医院感染学杂志》2021年第18期2759-2762,共4页Chinese Journal of Nosocomiology

基　　金：青海省卫生计生委科研基金资助项目(18M201061)。

摘　　要：目的分析慢性阻塞性肺疾病(COPD)肺部感染的病原学特点,并分析多药耐药铜绿假单胞菌(MDRPA)感染的危险因素。方法选取2017年1月-2019年12月青海省人民医院呼吸与危重症医学科诊治的COPD继发肺部感染患者372例,分析患者感染病原学特点,并根据病原学结果,将患者分为MDRPA组和非MDRPA组,分析患者MDRPA感染的危险因素。结果372例继发肺部感染COPD患者痰培养共检出病原菌441株,其中革兰阴性菌占67.12%,革兰阳性菌占24.72%,真菌占8.16%;铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌是主要的革兰阴性菌,对亚胺培南和美罗培南的耐药率较低,对1、2、3代头孢菌素类抗菌药物的耐药性较高;114株铜绿假单胞菌检出MDRPA 29株,多因素分析结果,混合感染、入住ICU是COPD继发肺部感染患者MDRPA感染的独立危险因素(P<0.05)。结论COPD患者肺部感染病原菌以铜绿假单胞菌多见,MDRPA菌株的产生与混合感染、入住ICU密切相关,临床治疗和护理工作中,应针对性给予相关措施,以提高患者治疗效果。OBJECTIVE To investigate the etiological characteristics of pulmonary infection in patients with chronic obstructive pulmonary disease(COPD)patients and analyze the risk factors for multidrug-resistant Pseudomonas aeruginosa(MDRPA)infection.METHODS A total of 372COPD patients with secondary pulmonary infection who were treated in respiratory and critical care medicine department of Qinghai Provincial People′s Hospital from Jan 2017to Dec 2019were enrolled in the study,the etiological characteristics of the infection were analyzed,the enrolled patients were divided into the MDRPA group and the non-MDRPA group according to the result of etiological test,and the risk factors for the MDRPA infection were observed.RESULTS Totally 441strains of pathogens were isolated from sputum specimens of the 372COPD patients with secondary pulmonary infection,67.12%of which were gram-negative bacteria,24.72%were gram-positive bacteria,and 8.16%were fungi.Pseudomonad aeruginosa,Klebsiella pneumoniae and Escherichia coli were the predominant species of gram-negative bacteria,the drug resistance rates to imipenem and meropenem were low,while the drug resistance rates to the 1st,2nd and 3rd generations of cephalosporins were high.29strains of MDRPA were identified among the 114strains of P.aeruginosa.The result of multivariate analysis showed that mixed infection and ICU stay were the independent risk factors for the MDRPA infection in the COPD patients with secondary pulmonary infection(P<0.05).CONCLUSION P.aeruginosais a common species of pathogens isolated from the COPD patients with pulmonary infection,the emergence of MDRPA strains is closely associated with the mixed infection and ICU stay.It is necessary to take targeted measures during clinical treatment and nursing so as to improve the therapeutic effect.

关 键 词：慢性阻塞性肺疾病 肺部感染 铜绿假单胞菌 危险因素 多药耐药菌株 

分 类 号：R563[医药卫生—呼吸系统]