慢性阻塞性肺疾病并发呼吸机相关性肺炎患者铜绿假单胞菌对抗生素的耐药性及其预后影响因素分析  

Analysis of antibiotic resistance and prognostic factors of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease complicated with ventilator-associated pneumonia

作　　者：宗玉刚 刘艳秋[1] 范海迪 姚万青[2] ZONG Yugang;LIU Yanqiu;FAN Haidi;YAO Wanqing(Department of Clinical Laboratory,Huaian First People’s Hospital Branch Hospital,Jiangsu Province,Huaian 223002,China;Department of Respiratory Medicine,Huaian First People’s Hospital Branch Hospital,Jiangsu Province,Huaian 223002,China)

机构地区：[1]江苏省淮安市第一人民医院分院检验科,江苏淮安223002 [2]江苏省淮安市第一人民医院分院呼吸科,江苏淮安223002

出　　处：《中国医药导报》2023年第22期150-153,共4页China Medical Herald

基　　金：江苏省自然科学基金资助项目(BK20191499)。

摘　　要：目的分析慢性阻塞性肺疾病(COPD)并发呼吸机相关性肺炎(VAP)患者铜绿假单胞菌(PA)对抗生素的耐药性及预后影响因素。方法回顾性采集2019年6月至2022年6月江苏省淮安市第一人民医院分院62例COPD并发VAP患者的临床资料,分析PA对抗生素耐药性,并根据入院28 d内临床转归分为病死组(18例)和生存组(44例),比较两组一般资料,采用二元logistic回归分析预后的影响因素。结果62例慢性阻塞性肺疾病并发VAP患者共培养出17株PA,总感染率为27.42%,对氨苄西林、复方新诺明、氨曲南、头孢唑林耐药率均超过90%;病死组临床肺部感染评分(CPIS)、中性粒细胞计数/淋巴细胞计数(NLR)、降钙素原(PCT)水平高于生存组,肠内营养支持、应用抑酸药占比低于生存组(P<0.05);经logistic回归分析,CPIS评分、NLR、PCT均为COPD并发VAP患者预后的危险因素,营养支持途径为保护因素(P<0.05)。结论COPD并发VAP患者PA对氨苄西林、复方新诺明、氨曲南等抗生素耐药率较高,且CPIS评分、NLR、PCT、肠内营养支持均为COPD并发VAP患者预后的影响因素。Objective To analyze the antibiotic resistance and prognostic factors of Pseudomonas aeruginosa(PA)in patients with chronic obstructive pulmonary disease(COPD)complicated with ventilator-associated pneumonia(VAP).Methods The clinical data of 62 patients with COPD complicated with VAP in the Huaian First People’s Hospital Branch Hospital from June 2019 to June 2022 were retrospectively collected,and the drug resistance of PA to antibiotics was analyzed.According to the clinical outcome within 28 days after admission,the patients were divided into death group(18 cases)and survival group(44 cases).The general data of the two groups were compared,and the influencing factors of prognosis were analyzed by logistic multiple regression.Results A total of 17 strains of PA were cultured from 62 patients with COPD complicated with VAP,the total infection rate was 27.42%,and the drug resistance rate to Ampicillin,Cotrimoxazole,Amtreonam and Cefazolin was more than 90%.The clinical pulmonary infection score(CPIS),neutrophil to lymphocyte ratio.(NLR)and procalcitonin(PCT)levels in the death group were higher than those in the survival group,and the proportion of enteral nutrition support and acid inhibitor use was lower than that in the survival group(P<0.05).Logistic regression analysis showed that CPIS score,NLR and PCT were risk factors for the prognosis of patients with COPD complicated with VAP,and nutritional support pathway were protective factors(P<0.05).Conclusion The drug resistance rate of PA in patients with chronic obstructive pulmonary disease complicated with VAP to Ampicillin,Compound Sulfamethoxazole,Amtreonam,and other antibiotics is high,and CPIS score,NLR,PCT,and enteral nutrition support are all factors affecting the prognosis of patients with COPD complicated with VAP.

关 键 词：慢性阻塞性肺疾病 呼吸机相关性肺炎 铜绿假单胞菌 抗生素 耐药性 预后 影响因素 

分 类 号：R563[医药卫生—呼吸系统]