85例新型冠状病毒感染重症患者合并感染病原菌的分布与耐药分析  

Analysis of distribution and drug resistance of pathogens in 85 severe COVID-19 patients with pathegenic bacteria infection

作　　者：查贺飞 史茜 刘春燕 李永鑫 伊贝拜汗·买卖提 张新[1] ZHA Hefei;SHI Qian;LIU Chunyan;LI Yongxin;Yibeibaihan Maimaiti;ZHANG Xin(Department of Clinical Laboratory,Hospital of Xinjiang Production and Construction Crops/Second Affiliated Hospital,Medical School of Shihezi University,Urumqi 830002,Xinjiang,China)

机构地区：[1]新疆生产建设兵团医院/石河子大学医学院第二附属医院检验科,乌鲁木齐830002

出　　处：《临床检验杂志》2024年第9期707-711,共5页Chinese Journal of Clinical Laboratory Science

基　　金：国家临床重点专科建设项目(兵财社[2023]16号);兵团重点领域科技攻关计划项目(2022AB030);新疆生产建设兵团医院青年基金项目(2022014)。

摘　　要：目的回顾性分析新型冠状病毒感染(COVID-19)重症患者的临床分布特征及病原菌感染情况。方法纳入2022年12月1日至2023年2月20日新疆生产建设兵团医院就诊的COVID-19重症且合并病原菌感染的患者85例,收集其临床资料及实验室检查结果,根据转归结果分为治愈组和死亡组,进一步分析各组患者感染病原菌的分布特征与耐药情况。结果85例COVID-19重症患者的中位年龄为82(75,84)岁,住院时长为14(9,23)d,最常见的基础疾病为高血压、心脏病和糖尿病。治愈组63例,死亡组22例,病死率高达25.9%。死亡组患者的白细胞计数、中性粒细胞/淋巴细胞比值、C反应蛋白均高于治愈组(P<0.05),但淋巴细胞百分数低于治愈组(P<0.05)。85例患者中共分离出128株病原菌,其中革兰阳性菌21株(16.4%),以金黄色葡萄球菌为主;革兰阴性菌66株(51.6%),以肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌为主;真菌41株(32.0%),以白念珠菌为主。耐苯唑西林的金黄色葡萄球菌(MRSA)比率高达56%,耐碳青霉烯类中的肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌比率分别为14%、50%和18%。结论高龄、患有基础疾病的COVID-19重症患者在合并耐碳青霉烯的肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌以及较高比例的MRSA时,临床应合理选择抗菌药物并采取有效措施,预防多重耐药菌的传播,降低病亡风险。Objective To analyze the clinical characteristics and pathogen infection of severe patients with COVID-19 retrospectively.Methods The clinical data and laboratory test results of 85 severe COVID-19 patients combined with pathogenic bacterial infection admitted to the Hospital of Xinjiang Production and Construction Corps from December 1,2022 to February 20,2023 were collected.The patients were divided into the cure group and death group based on the outcome.Meanwhile,the distribution and drug resistance of the infected pathogens were analyzed.Results The median age and length of hospitalization of 85 patients with severe COVID-19 were 82(75,84)years old and 14(9,23)days,respectively.Their most common underlying diseases were hypertension,heart disease,and diabetes.There were 63 patients in the cure group and 22 in the death group,with a mortality rate as high as 25.9%.The levels of white blood cell count,neutrophil to lymphocyte ratio,and C-reactive protein in the patients of the death group were significanly higher than those in the cure group(P<0.05).However,the percentage of lymphocytes was the opposite(P<0.05).A total of 128 strains of pathogenic bacteria were isolated from 85 patients.Among them,21 strains(16.4%)were Gram-positive bacteria,predominantly Staphylococcus aureus.66 strains(51.6%)were Gram-negative bacteria,mainly Klebsiella pneumoniae,Acinetobacter baumannii,and Pseudomonas aeruginosa.41 strains(32.0%)were fungi,primarily Candida albicans.The proportion of methicillin-resistant Staphylococcus aureus(MRSA)was as high as 56%,while those of carbapenem-resistant Klebsiella pneumoniae,Acinetobacter baumannii,and Pseudomonas aeruginosa were 14%,50%,and 18%,respectively.Conclusion The severe COVID-19 patients who are elderly or have underlying diseases may be infected with carbapenem-resistant Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and MRSA.In clinical practice,rational selection of antibiotics should be made and effective measures should be taken to prevent the spread of

关 键 词：新型冠状病毒感染 病原菌感染 耐药情况 

分 类 号：R446.5[医药卫生—诊断学]