慢性阻塞性肺疾病急性加重期患者泛耐药铜绿假单胞菌感染危险因素及毒力因子  

Risk factors for pandrug-resistant Pseudomonas aeruginosa infection and virulence factors in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：胡昭君 田珍 周青 李卫鑫 聂雷霞 HU Zhao-jun;TIAN Zhen;ZHOU Qing;LI Wei-xin;NIE Lei-xia(Taikang Tongji(Wuhan)Hospital,Wuhan,Hubei 430050,China)

机构地区：[1]泰康同济(武汉)医院眼科,湖北武汉430050 [2]泰康同济(武汉)医院骨科,湖北武汉430050 [3]泰康同济(武汉)医院康复科,湖北武汉430050 [4]武汉市江夏区第一人民医院呼吸与危重症医学科,湖北武汉430050 [5]泰康同济(武汉)医院口腔科,湖北武汉430050

出　　处：《中华医院感染学杂志》2023年第6期811-815,共5页Chinese Journal of Nosocomiology

基　　金：湖北省科研基金资助项目(2020K2211)。

摘　　要：目的 分析慢性阻塞性肺疾病急性加重期(AECOPD)患者感染泛耐药铜绿假单胞菌(PDRPA)危险因素及毒力因子。方法 选取2019年1月-2021年1月泰康同济医院收治的100例AECOPD并发肺部感染患者,分析肺部感染病原菌分布和耐药性,根据病原学结果分为PDRPA组12例和非PDRPA组33例,收集两组一般资料,采用Logistic回归分析影响AECOPD感染PDRPA的危险因素,并采用多重聚合酶链式反应(PCR)检测毒力因子表达。结果 100例AECOPD并发肺部感染患者中革兰阴性菌占67.88%、革兰阳性菌占24.24%、真菌占7.88%,以铜绿假单胞菌(PA)、肺炎克雷伯菌和大肠埃希菌最为多见。PA对氨苄西林、环丙沙星、氨苄西林/舒巴坦及头孢他啶的耐药率均>50%;肺炎克雷伯菌对氨苄西林、头孢他啶的耐药率均>60%。单因素分析显示,气管插管、机械通气、入住重症监护病房(ICU)及服用碳青霉烯类抗菌药物的AECOPD并发肺部感染患者PDRPA感染发生率升高(P<0.05);Logistic多因素回归分析显示,气管插管为AECOPD患者感染PDRPA的危险因素(P<0.05)。AECOPD患者感染PDRPA的毒力基因以toxA、exoT占比最高。结论 AECOPD肺部感染以PA多见,PDRPA菌株的产生与气管插管相关,且PDRPA毒力因子以toxA、exoT为主。OBJECTIVE To analyze the risk factors for pandrug-resistant Pseudomonas aeruginosa(PDRPA) infection and virulence factors in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). METHODS A total of 100 AECOPD patients who were complicated with pulmonary infection and were treated in Taikang Tongji Hospital from Jan 2019 to Jan 2021 were enrolled in the study. The distribution and drug resistance of pathogens causing the pulmonary infection were observed. The enrolled patients were divided into the PDRPA group with 12 cases and the non-PDRPA group with 33 cases according to the result of etiological test. The baseline data were collected from the two groups of patients, logistic regression analysis was performed for the risk factors for the PDRPA infection in the AECOPD patients, and expressions of virulence factors were detected by means of multiple polymerase chain reaction(PCR). RESULTS Among the pathogens isolated from the 100 AECOPD patients complicated with pulmonary infection, gram-negative bacteria accounted for 67.88%, gram-positive bacteria accounted for 24.24%, and fungi accounted for 7.88%;P. aeruginosa, Klebsiella pneumoniae and Escherichia coli were the most common species of pathogens. The drug resistance rates of the P.aeruginosa strains to ampicillin, ciprofloxacin, ampicillin-sulbactam and ceftazidime were more than 50%, the drug resistance rates of the K.pneumoniae strains to ampicillin and ceftazidime were more than 60%. Univariate analysis showed that the incidence of PDRPA infection was increased among the AECOPD patients complicated with pulmonary infection who were treated with endotracheal intubation, mechanical ventilation, ICU stay and carbapenems(P<0.05). Multivariate logistic regression analysis indicated that the endotracheal intubation was the risk factor for the PDRPA infection in the AECOPD patients(P<0.05). toxA and exoT were dominant among the virulence genes in PDRPA strains isolated from AECOPD patients with infection. CONCLUSION The P.aeruginosa is

关 键 词：慢性阻塞性肺疾病 急性加重期 泛耐药铜绿假单胞菌 危险因素 毒力因子 

分 类 号：R563[医药卫生—呼吸系统]