重症肺炎患者多重耐药菌感染病原学特点及危险因素分析  

Etiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria Infection in Patients with Severe Pneumonia

作　　者：孙大敬 龙慧珍[2] Sun Da-jing;Long Hui-zhen(IThe First Provincial Hospital of Henan Provincial People's Hospital,The First Outpatient Department of Departments under Henan Province,Zhengzhou 450000;Henan province Chest Hospital,Zhengzhou 450000)

机构地区：[1]河南省人民医院省直第一医院,河南省直属机关第一门诊部,郑州450000 [2]河南省胸科医院,郑州450000

出　　处：《国外医药（抗生素分册）》2021年第5期312-315,共4页World Notes on Antibiotics

摘　　要：目的探讨重症肺炎患者多重耐药菌(MDR)感染病原学特点及危险因素。方法选取2017年5与月—2020年6月我院收治的110例重症肺炎患者为研究对象,收集研究对象基本资料,对感染组患者的痰液进行培养,分析检出菌及药敏实验结果;根据患者是否合并MDR感染,分为MDR感染组(42例)和非MDR感染组(68例)。采用多因素Logisitic回归分析重症肺炎患者MDR感染的危险因素。结果多因素Logistic回归分析显示,合并肺部原发病、侵入性检查或治疗是重症肺炎患者MDR发生独立危险因素。42例重症肺炎合并MDR患者共检出病原菌87株,革兰阴性菌占63.22%(55/87),革兰阳性菌占31.03%(27/87),真菌占5.75%(5/87)。革兰阳性球菌中,溶血性葡萄球菌、金黄色葡萄球菌、粪肠球菌均对庆大霉素、克林霉素和红霉素的耐药率较高,对替考拉宁、万古霉素耐药率低。革兰阴性杆菌中,铜绿假单胞菌对亚胺培南的耐药率最低,头孢吡肟次之;肺炎克雷伯菌、鲍曼不动杆菌则对妥布霉素、环丙沙星的耐药率较低。结论合并肺部原发病、侵入性检查或治疗是重症肺炎患者MDR发生独立危险因素;重症肺炎合并MDR以革兰阴性杆菌最为常见,患者需及时进行细菌培养和药敏试验,并根据感染病原菌的特点和药敏结果采取个体化、精准化的治疗方案。Objective To explore the etiological characteristics and risk factors of multi-drug resistant bacteria(MDR)infection in patients with severe pneumonia.Methods A total of 110 patients with severe pneumonia admitted to the hospital were enrolled as the research objects between May 2017 and June 2020,and their basic data were collected.The culture of sputum in infection group was conducted to analyze the pathogens and results of drug susceptibility tests.According to presence or absence of MDR infection,they were divided into infection group(42 cases)and non-infection group(68 cases).The risk factors of MDR infection were analyzed by multivariate Logisitic regression analysis.Results Multivariate Logistic regression analysis showed that primary pulmonary diseases,invasive examination or treatment were independent risk factors of MDR in patients with severe pneumonia.Among the 42 patients with severe pneumonia and MDR,there were 87 strains of pathogens,including Gram-negative bacteria[63.22%(55/87)],Gram-positive bacteria[31.03%(27/87)]and fungi[5.75%(5/87)].In Gram-positive bacteria,drug resistance rates of Staphylococcus hemolyticus,Staphylococcus aureus and Enterococcus faecalis were high to gentamicin,clindamycin and erythromycin,while the resistance rates were low to teicoplanin and vancomycin.In Gram-negative bacteria,drug resistance rate of Pseudomonas aeruginosa was the lowest to imipenem,followed by cefepime.The drug resistance rates of Klebsiella pneumoniae and Acinetobacter baumannii were low to tobramycin and ciprofloxacin.Conclusion Primary pulmonary diseases and invasive examination or treatment are independent risk factors of MDR in patients with severe pneumonia.The pathogens are mainly on Gram-negative bacteria in patients with severe pneumonia and MDR.The bacterial culture and drug susceptibility tests should be conducted timely in patients,individualized and precise treatment plans should be taken based on the characteristics of infectious pathogens and drug susceptibility results.

关 键 词：重症肺炎 多重耐药菌感染 病原学 危险因素 

分 类 号：R978.1[医药卫生—药品]