阻塞性睡眠呼吸暂停低通气综合征合并肺炎患者呼吸道病原菌构成及耐药性分析  

Composition and Drug Resistance of Respiratory Tract Pathogens in Patients with Obstructive Sleep Apnea Hypopnea Syndrome Complicated with Pneumonia

作　　者：王鹏 姚苏梅[1] 吕学东[1] WANG Peng;YAO Sumei;LYU Xuedong(Department of Respiratory Medicine,Nantong First People's Hospital/the Second Affiliated Hospital of Nantong University/Nantong Hospital of Shanghai Renji Hospital,Nantong 226000,China)

机构地区：[1]江苏省南通市第一人民医院,南通大学第二附属医院,上海仁济医院南通医院呼吸科,226000

出　　处：《实用心脑肺血管病杂志》2025年第1期71-74,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省卫生健康委员会科研项目(Z2023279);南通市卫健委科研项目(MSZ2022012)。

摘　　要：目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并肺炎患者呼吸道病原菌构成及耐药性。方法选取2022年11月—2023年5月在南通市第一人民医院呼吸科住院治疗的312例OSAHS合并肺炎患者为研究对象。收集患者痰标本,进行呼吸道病原菌鉴定及主要呼吸道病原菌耐药性分析。结果312例OSAHS合并肺炎患者中123例培养出呼吸道病原菌,培养阳性率为39.4%。共培养出126株呼吸道病原菌,其中革兰阳性菌59株(46.8%),分别为肺炎链球菌33株、金黄色葡萄球菌26株;革兰阴性菌67株(53.2%),分别为肺炎克雷伯菌39株、大肠埃希菌16株、铜绿假单胞菌5株、流感嗜血杆菌3株、奇异变形杆菌2株、肠杆菌2株。肺炎链球菌对氯霉素(100.0%)、克林霉素(97.0%)、头孢西丁(93.9%)的敏感率较高,对苯唑西林(93.9%)、四环素(87.9%)、多西环素(84.9%)、青霉素(80.8%)的耐药率较高;金黄色葡萄球菌对氯霉素(100.0%)、克林霉素(96.2%)、复方磺胺甲噁唑片(92.3%)、头孢西丁(92.3%)的敏感率较高,对苯唑西林(93.9%)、青霉素(80.8%)的耐药率较高。肺炎克雷伯菌对庆大霉素(94.9%)、阿奇霉素(92.3%)、氯霉素(89.5%)、环丙沙星(84.6%)的敏感率较高,对头孢西丁(100.0%)、阿莫西林-克拉维酸(94.9%)、复方磺胺甲噁唑片(92.3%)、四环素(87.2%)、多西环素(87.2%)的耐药率较高。126株呼吸道病原菌中69株(54.7%)为多重耐药菌。结论OSAHS合并肺炎患者呼吸道病原菌培养阳性率为39.4%,常见呼吸道病原菌为肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌;肺炎链球菌对苯唑西林、四环素、多西环素、青霉素的耐药率较高,金黄色葡萄球菌对苯唑西林、青霉素的耐药率较高,肺炎克雷伯菌对头孢西丁、阿莫西林-克拉维酸、复方磺胺甲噁唑片、四环素、多西环素的耐药率较高,且多重耐药菌占比较高。Objective To analyze the composition and drug resistance of respiratory tract pathogens in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with pneumonia.Methods A total of 312 patients with OSAHS complicated with pneumonia who were hospitalized in the Department of Respiratory Medicine of Nantong First People's Hospital from November 2022 to May 2023 were selected as the study subjects.Sputum samples of patients were collected for identification of respiratory pathogens and analysis of drug resistance of main respiratory pathogens.Results A total of 123 respiratory pathogens were cultured form 312 patients with OSAHS complicated with pneumonia,and the positive rate of culture was 39.4%.A total of 126 strains of respiratory pathogens were cultured,including 59 strains(46.8%)of Gram-positive bacteria(including 33 strains of Streptococcus pneumoniae and 26 strains of Staphylococcus aureus)and 67 strains(53.2%)of Gram-negative bacteria(including 39 strains of Klebsiella pneumoniae,16 strains of Escherichia coli,5 strains of Pseudomonas aeruginosa,3 strains of Haemophilus influenzae,2 strains of Proteus mirabilis and 2 strains of Enterobacter).Streptococcus pneumoniae had higher sensitivity rates to chloramphenicol(100.0%),clindamycin(97.0%)and cefoxitin(93.9%),and had higher resistance rates to oxacillin(93.9%),tetracycline(87.9%),doxycycline(84.9%)and penicillin(80.8%).Staphylococcus aureus had higher sensitivity rates to chloramphenicol(100.0%),clindamycin(96.2%),compound sulfamethoxazole tablets(92.3%)and cefoxitin(92.3%),and had higher resistance rates to oxacillin(93.9%)and penicillin(80.8%).Klebsiella pneumoniae had higher sensitivity rates to gentamicin(94.9%),azithromycin(92.3%),chloramphenicol(89.5%)and ciprofloxacin(84.6%),and had higher resistance rates to cefoxitin(100.0%),amoxicillin-clavulanic acid(94.9%),compound sulfamethoxazole tablets(92.3%),tetracycline(87.2%)and doxycycline(87.2%).Among 126 strains of respiratory pathoges bacteria,69(54.7%)were multi-drug resistant bacte

关 键 词：睡眠呼吸暂停低通气综合征 肺炎 病原菌 耐药 

分 类 号：R749.79[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]