支气管扩张合并肺部感染患者病原菌分布及药敏试验结果对抗菌药物应用的影响  

Distribution of Pathogenic Bacteria in Patients with Bronchiectasis Complicated by Pulmonary Infection and Effect of Drug Sensitivity Test Result on Use of Antibacterial Drugs

作　　者：杜丽君 董琼 DU Li-jun;DONG Qiong(Department of Respiratory and Critical Medicine,the Central Hospital of Nanchong City,Nanchong,Sichuan 637000,China)

机构地区：[1]南充市中心医院呼吸与重症医学科,四川南充637000

出　　处：《解放军医药杂志》2022年第2期66-69,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：南充市科技计划项目(20YFZJ0133)。

摘　　要：目的探讨病原菌在支气管扩张合并肺部感染患者中的分布情况,了解药敏试验结果对抗菌药物合理使用的影响。方法选取2017年6月—2019年6月确诊的支气管扩张合并肺部感染155例,分析患者感染致病菌的种类与分布,统计抗菌药物使用情况及致病菌的药敏试验结果,应用多因素Logistic回归分析支气管扩张合并肺部感染患者用药合理性的影响因素。结果155例支气管扩张合并肺部感染患者痰液标本中,检出阳性样本81例(52.26%),分离出菌株95株,革兰阴性菌69株(72.63%),其中铜绿假单胞菌33株(47.83%);革兰阳性菌26株(27.37%)。产超广谱β-内酰胺酶(ESBLs)菌对复方磺胺甲口恶唑、头孢曲松、头孢替坦及氨苄西林的耐药率为100.00%,对环丙沙星耐药率为95.00%。注射剂药物中左氧氟沙星、复方磺胺甲口恶唑的药物利用指数均>1。支气管扩张合并肺部感染患者感染病原菌种类、产ESBLs菌、药敏用药和药物种类均是患者用药合理性的影响因素(P<0.05)。结论革兰阴性菌是支气管扩张合并肺部感染患者的主要致病菌,临床治疗时为保证药物的有效性及安全性,应联合药敏试验结果选择合适的抗菌药物。Objective To explore distribution of pathogenic bacterium in patients with bronchiectasis complicated by pulmonary infection,and to further understand effect of drug sensitivity test result on rational use of antibacterial drugs.Methods A total of 155 patients with bronchiectasis complicated by pulmonary infection who had been confirmed between June 2017 and June 2019 were selected as research subjects.Types and distribution of pathogenic bacterium were analyzed,and the use of antibacterial drugs and drug sensitivity test result of pathogenic bacteria were analyzed.Multivariate Logistic regression analysis was used to analyze factors affecting the rationality of medication in patients with bronchiectasis complicated by pulmonary infection.Results Among 155 sputum specimens of patients with bronchiectasis complicated by pulmonary infection,81 positive samples(52.26%)were detected,and 95 strains were isolated;69 gram-negative bacteria(72.63%),which included 33 strains(47.83%)of pseudomonas aeruginosa,and 26 strains(27.37%)of gram-positive bacteria were detected.The resistance rates of extended-spectrumβ-lactamase(ESBLs)-producing bacteria to Compound Sulfamethoxazole,Ceftriaxone,Cefotetan and Ampicillin were 100.00%,and its resistance rate to Ciprofloxacin was 95.00%.The drug utilization indexes(DUI)of both Levofloxacin and Compound Sulfamethoxazole among injection drugs were more than 1.Infectious types of pathogenic bacterium,ESBLs-producing bacteria,the use of drugs according to drug sensitivity and types of selected drugs were all influencing factors for the rationality of patients'medication in patients with bronchiectasis complicated by pulmonary infection(P<0.05).Conclusion Gram negative bacterium are the main pathogenic bacterium in patients with bronchiectasis complicated by pulmonary infection.Appropriate antibacterial drugs should be selected according to results of drug sensitivity test in order to ensure effectiveness and safety of drugs in clinic.

关 键 词：支气管扩张症 肺部感染 铜绿假单胞菌 超广谱Β-内酰胺酶 氧氟沙星 磺胺甲基异恶唑 

分 类 号：R562.22[医药卫生—呼吸系统]