冠心病合并2型糖尿病患者院内感染的病原学研究  

Etiological study on nosocomial infection in patients with coronary heart disease complicated with type 2 diabetes mellitus

作　　者：贾静涛 石小霞[1] 李杰[1] 邬博 雷媛媛 李瑞英 JIA Jingtao;SHI Xiaoxia;LI Jie;WU Bo;LEI Yuanyuan;LI Ruiying(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院,河南南阳473000

出　　处：《中国病原生物学杂志》2025年第5期619-622,627,共5页Journal of Pathogen Biology

摘　　要：目的探讨冠心病合并2型糖尿病患者院内感染的主要病原体及其耐药性,为临床治疗提供科学依据。方法选取本院接诊的182例冠心病合并2型糖尿病院内感染患者为本次研究对象,收集各类感染标本,进行细菌培养和药敏试验。运用聚合酶链式反应(PCR)技术对检出的耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)的耐药基因进行检测。结果对比感染组与未感染组患者临床资料,两组患者有吸烟史、合并慢性阻塞性肺疾病病史、NY-HA心功能分级≥Ⅲ级、住院时间≥7 d、血浆白蛋白<30 g/L的病例数构成比对比差异具有统计学意义(P<0.05)。182例院内感染患者中,98例为呼吸系统感染,32例为泌尿系统感染,25例为消化系统感染,13例为皮肤软组织系统感染,5例为血液系统感染,9例为其他部位感染。共检出病原菌182株,革兰阴性菌占比53.3%,革兰阳性菌占比41.75%,真菌占比4.95%。革兰阴性菌主要为肺炎克雷伯菌和大肠埃希菌,革兰阳性菌主要为金黄色葡萄球菌,真菌中主要为白色假丝酵母菌。45株肺炎克雷伯菌中,检出16株CRKP,检出率为35.56%。16株CRKP菌株中,9株携带KPC型,2株携带NDM型,2株携带IMP型,1株携带VIM型,1株携带KPC+NDM型,1株携带KPC+IMP型。对比CSKP与CRKP组菌株对常见抗菌药物的耐药率显示,对哌拉西林/他唑巴坦、头孢呋辛、头孢他啶、头孢吡肟、亚胺培南、庆大霉素、阿米卡星、左氧氟沙星、环丙沙星、复方新诺明的耐药率对比差异均具有统计学意义(P<0.05)。结论冠心病合并2型糖尿病患者院内感染病原菌种类繁多,主要为革兰阴性菌,以肺炎克雷伯菌为主。肺炎克雷伯菌的耐药性问题较为严重,特别是CRKP检出率高,耐药基因型多样,给临床治疗带来极大挑战。Objective To explore the main pathogens of nosocomial infection in patients with coronary heart disease complicated with type 2 diabetes mellitus and their drug resistance,so as to provide scientific basis for clinical treatment.Methods A total of 182 patients with coronary heart disease complicated with type 2 diabetes mellitus and nosocomial infection who were admitted to our hospital were selected as the research objects of this study.Various infection specimens were collected for bacterial culture and drug sensitivity test.The drug resistance genes of carbapenem-resistant Klebsiella pneumoniae(CRKP)detected were detected by polymerase chain reaction(PCR)technology.Results By comparing the clinical data of infected and uninfected patients,there were statistically significant differences between the two groups in the constituent ratios of cases with smoking history,history of complicated chronic obstructive pulmonary disease,NY-HA cardiac function classification≥gradeⅢ,hospitalization time≥7 days,and plasma albumin<30 g/L(P<0.05).Among the 182 nosocomial infection patients,98 cases were respiratory system infections,32 cases were urinary system infections,25 cases were digestive system infections,13 cases were skin and soft tissue system infections,5 cases were blood system infections,and 9 cases were infections in other parts.A total of 182 pathogenic bacteria were detected.Gram-negative bacteria accounted for 53.3%,Gram-positive bacteria accounted for 41.75%,and fungi accounted for 4.95%.Among Gram-negative bacteria,K.pneumoniae and Escherichia coli were the main ones.Among Gram-positive bacteria,Staphylococcus aureus was the main one.Among fungi,Candida albicans was the main one.Among 45 strains of K.pneumoniae,16 strains of CRKP were detected,with a detection rate of 35.56%.Among the 16 CRKP strains,9 strains carried KPC type,2 strains carried NDM type,2 strains carried IMP type,1 strain carried VIM type,1 strain carried KPC+NDM type,and 1 strain carried KPC+IMP type.Comparing the drug resistance rate

关 键 词：冠心病 2型糖尿病 院内感染 耐碳青霉烯类肺炎克雷伯菌 

分 类 号：R378[医药卫生—病原生物学]