新型冠状病毒肺炎患者合并感染的临床特征  

Clinical characteristics of co-infection in COVID-19 patients

作　　者：刘兰[1] 黄红丽[2] 加明明 李瑞云[1] 蔡璇[3] 吴小军[1] LIU Lan;HUANG Hongli;JIA Mingming;LI Ruiyun;CAI Xuan;WU Xiaojun(Dept.of Pulmonary and Critical Medicine,Hubei,China;Dept.of Paediatrics,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院呼吸与危重症科,湖北武汉430060 [2]武汉大学人民医院儿科,湖北武汉430060 [3]武汉大学人民医院检验科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2023年第6期667-672,共6页Medical Journal of Wuhan University

摘　　要：目的:对新型冠状病毒肺炎(COVID-19)患者住院期间血液、体液培养阳性的病原学、临床资料进行分析,明确COVID-19合并其他病原菌感染情况,指导COVID-19治疗。方法:收集2020年1—5月武汉大学人民医院42例患者临床资料,包括性别、年龄、住院时长、合并基础疾病、转归、侵入性操作、标本类型、微生物、耐药情况,分析COVID-19患者临床特征及合并感染病原菌情况。结果:42例患者中位年龄为66.5岁,合并基础疾病患者占92.9%;进行侵入性操作患者占76.2%(32/42);共培养出67株阳性病原菌,主要病原菌为真菌(16株,23.9%)、鲍曼不动杆菌(14株,20.9%)、铜绿假单胞菌(7株,10.4%)、大肠埃希菌(6株,8.9%);感染部位依次为呼吸道、泌尿道、血液、皮肤;鲍曼不动杆菌在侵入性操作组高于未行侵入性操作组(P<0.05);大肠埃希菌、奇异变形杆菌在侵入性操作组低于未行侵入性操作组(P<0.05)。鲍曼不动杆菌、肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌对碳青霉烯类药物耐药率分别为100%、66.6%、42.9%、0,未发现耐甲氧西林的金黄色葡萄球菌,未发现对万古霉素耐药的革兰阳性球菌。结论:COVID-19合并细菌感染病原菌以革兰阴性菌及真菌为主,感染部位以呼吸道为主,主要病原菌为鲍曼不动杆菌。侵入性操作和合并基础疾病是引起合并感染的主要原因,合并细菌或真菌感染对COVID-19的严重程度、患者死亡起着重要的促进作用。侵入性操作是患者合并感染的重要原因,且合并感染的菌株存在多重耐药,临床上要尽量减少或避免侵入性治疗。Objective:To analyze the etiology and clinical data of positive blood and body fluid cultures of patients with coronavirus disease 2019(COVID-19)during their hospitalization,clarify the situation of COVID-19 combined with other pathogen infections,and guide the treatment of COVID-19.Methods:We collected the clinical data of 42 COVID-19 cases in Renmin Hospital of Wuhan University from January 2020 to May 2020,including gender,age,length of stay,combined underlying diseases,outcome,invasive procedures,specimen types,microorganisms,and drug resistance,and analyzed their clinical characteristics and co-infection pathogenic bacteria.Results:The median age of the 42 patients was 66.5 years,and 92.9%had underlying diseases;76.2%(32/42)of patients underwent invasive procedures;67 positive pathogens were cultured,and the most common pathogens were fungi(16 strains,23.9%),Acinetobacter baumannii(14 strains,20.9%),Pseudomonas aeruginosa(7 strains,10.4%),and Escherichia coli(6 strains,8.9%).The infection sites were respiratory tract,urinary tract,blood,and skin in order.The posotive rate of Acinetobacter baumannii in the invasive operation group was higher than that in the non-invasive operation group(P<0.05).The posotive rates of Escherichia coli and Proteus mirabilis were lower in invasive operation group than in non-invasive operation group(P<0.05).The resistance rates of Acinetobacter baumannii,Klebsiel-la pneumoniae,Pseudomonas aeruginosa,and Escherichia coli to carbapenem drugs were 100%,66.6%,42.9%,and 0,respectively.No methicillin-resistant Staphylococcus aureus was found,and no Gram-positive cocci resistant to vancomycin was found too.Conclusion:The pathogens of COVID-19 cases combined with bacterial infections were mainly Gram-negative bacteria and fungi,the coinfections were seen most frequently in respiratory tract,and the main pathogen was Acinetobacter baumannii.Invasive operations and combined underlying diseases were the main causes of combined infections.Combined bacterial or fungal infections played an imp

关 键 词：新型冠状病毒肺炎 病原学 耐药 侵入性操作 

分 类 号：R446.1[医药卫生—诊断学]