老年慢性阻塞性肺疾病继发MRSA感染耐药性、分子流行病学及危险因素  

Drug resistance,molecular epidemiological characteristics and risk factors for secondary MRSA infection in elderly patients with chronic obstructive pulmonary disease

作　　者：李哲[1] 王春雷[2] 姜新[3] LI Zhe;WANG Chun-lei;JIANG Xin(Hospital of Changchun University of Technology,Changchun,Jilin 130000,China;不详)

机构地区：[1]长春工业大学医院内科,吉林长春130000 [2]长春工业大学医院北湖卫生所,吉林长春130000 [3]吉林大学第一医院体检中心,吉林长春130000

出　　处：《中华医院感染学杂志》2023年第13期1949-1953,共5页Chinese Journal of Nosocomiology

基　　金：吉林省高教科研基金资助项目(JGJXZ2019D12)。

摘　　要：目的探究老年慢性阻塞性肺疾病(COPD)患者继发耐甲氧西林金黄色葡萄球菌(MRSA)感染的耐药性、分子流行病学及危险因素。方法选择2020年5月-2022年5月长春工业大学医院收治的160例老年COPD继发感染患者,行病原学检查、MRSA鉴定、药敏试验,分析COPD继发MRSA感染的危险因素。采用聚合酶链反应(PCR)法检测MRSA耐药基因、毒力基因。结果160例患者检出病原菌257株,以铜绿假单胞菌、金黄色葡萄球菌为主,28例患者为MRSA感染,MRSA检出率60.87%(28/46),其余132例患者非MRSA感染;MRSA对β-内酰胺类药100.00%耐药,对万古霉素、替考拉宁、利奈唑胺100.00%敏感;MRSA毒力基因以fnbA、hla、hld阳性率最高为100.00%,耐药基因以mecA阳性率最高为100.00%;MRSA组病程≥3年、合并糖尿病、混合感染、气管切开/插管操作、机械通气、入住重症监护室(ICU)、细菌分离前住院≥7 d、使用抗菌药物≥5次/年、使用免疫抑制剂比例高于非MRSA组(P<0.05);合并糖尿病、使用抗菌药物是影响老年COPD患者继发MRSA感染的危险因素(P<0.05)。结论老年COPD患者继发MRSA感染率较高,MRSA对多数抗菌药物耐药且携带多种耐药基因和毒力基因,故应重点关注合并糖尿病、使用抗菌药物≥5次/年的MRSA感染高危者,合理用药。OBJECTIVE To explore the drug resistance,molecular epidemiological characteristics and risk factors for secondary methicillin-resistant Staphylococcus aureus(MRSA)infection in elderly patients with chronic obstructive pulmonary disease(COPD).METHODS A total of 160 elderly COPD patients who were complicated with secondary infection and treated in Hospital of Changchun University of Technology from May 2020 to May 2022 were enrolled in the study.The etiological test,identification of MRSA and drug susceptibility testing were carried out for the enrolled patients.The risk factors for the secondary MRSA infection in the COOPD patients were analyzed,and the drug resistance genes and virulence genes in the MRSA strains were detected by polymerase chain reaction(PCR).RESULTS Totally 257 strains of pathogens were isolated from the patients,among which Pseudomonas aeruginosa and S.aureus were dominant.Totally 28 patients had MRSA infection,the isolation rate of MRSA was 60.87%(28/46),and the rest of 132 patients had non-MRSA infection.The drug resistance rate of the MRSA strains toβ-lactams was 100.00%,and the drug susceptibility rates to vancomycin,teicoplanin and linezolid were 100.00%.The positive rates of fnbA,hla and hld were the highest(100.00%)among the virulence genes in the MRSA strains;the positive rate of mecA was the highest(100.00%)among the drug resistance genes.The proportions of patients with course of disease no less than 3 years,diabetes mellitus,mixed infection,endotracheal/intonation,mechanical ventilation,intensive care unit(ICU)stay,length of hospital stay no less than 7 days before isolation of strains,use of antibiotics no less than 5 times/year and use of immunosuppressants were significantly higher in the MRSA group than in the non-MRSA group(P<0.05).Complication with diabetes mellitus and use of antibiotics were the risk factors for secondary MRSA infection in the elderly patients with COPD(P<0.05).CONCLUSION The incidence of secondary MRSA infection is high among the elderly patients with COPD

关 键 词：慢性阻塞性肺疾病 老年患者 耐甲氧西林金黄色葡萄球菌 毒力基因 耐药基因 危险因素 

分 类 号：R563[医药卫生—呼吸系统]