伴下呼吸道多重耐药菌感染的慢性阻塞性肺病患者病原菌分布及危险因素分析
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摘要
目的 探讨伴下呼吸道多重耐药菌感染的慢性阻塞性肺病(COPD)患者病原菌分布及其危险因素。方法 选取2017年1月至2018年6月我院收治的138例COPD伴下呼吸道感染患者作为研究对象,根据下呼吸道分泌物是否分离出多重耐药菌将患者分为多重耐药组(MDR组,71例)和非多重耐药组(NMDR组,67例)。采用全自动细菌鉴定仪对菌种进行鉴定,采用K-B纸片法进行药敏试验,并分析多重耐药菌感染的危险因素。结果 多重耐药组患者共分离出84株病原菌,其中革兰阴性菌所占比例最高,为58.33%;革兰阳性菌与真菌分别占22.62%和19.05%。MDR组与NMDR组患者在COPD分级、住院时间、机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史方面差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示机械通气治疗、侵入性操作、使用糖皮质激素、长期使用抗菌药物及糖尿病史是多重耐药菌感染的独立危险因素(P<0.05)。结论 COPD伴下呼吸道多重耐药菌感染病原菌以革兰阴性菌为主,机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史是发生感染的独立危险因素。建议根据病原菌种类选择相应的敏感药物,并采取针对危险因素的有效措施。
Objective To investigate the distribution of pathogens and risk factors in patients with chronic obstructive pulmonary disease(COPD) and infection with multi drug resistant bacteria in lower respiratory tract. Methods 138 COPD patients with lower respiratory tract infection admitted to our hospital from January 2017 to June 2018 were selected as the study subjects. According to the isolation of multidrug-resistant bacteria from lower respiratory tract secretions, the patients were divided into multidrug-resistance group(MDR group, 71 cases) or non-multidrug-resistance group(NMDR group, 67 cases). The bacterial strains were identified using automatic bacterial identification instrument; drug sensitivity test was carried out using K-B disc method; the risk factors of multi-drug resistant bacterial infection were analyzed. Results A total of 84 pathogenic bacteria were isolated from the 71 patients in MDR group, in which Gram-negative bacteria accounted for the highest proportion(58.33%); Gram-positive bacteria and fungi accounted for 22.62% and 19.05% respectively. There were significant differences between MDR group and NMDR group in COPD classification, hospitalization length, mechanical ventilation treatment, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes mellitus(all P<0.05). Multivariate logistic regression analysis showed that mechanical ventilation, invasive manipulation, glucocorticoid use, long-term use of antibiotics and history of diabetes were independent risk factors for multidrug-resistant bacterial infection(P<0.05). Conclusion Gram-negative bacteria were predominant in COPD with multidrug-resistant bacterial infection in lower respiratory tract. Mechanical ventilation, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes were independent risk factors for the infection. It is suggested that sensitive drugs should be selected according to the types of pathogens and effective measures should be taken to deal with the risk factors.
Objective To investigate the distribution of pathogens and risk factors in patients with chronic obstructive pulmonary disease(COPD) and infection with multi drug resistant bacteria in lower respiratory tract. Methods 138 COPD patients with lower respiratory tract infection admitted to our hospital from January 2017 to June 2018 were selected as the study subjects. According to the isolation of multidrug-resistant bacteria from lower respiratory tract secretions, the patients were divided into multidrug-resistance group(MDR group, 71 cases) or non-multidrug-resistance group(NMDR group, 67 cases). The bacterial strains were identified using automatic bacterial identification instrument; drug sensitivity test was carried out using K-B disc method; the risk factors of multi-drug resistant bacterial infection were analyzed. Results A total of 84 pathogenic bacteria were isolated from the 71 patients in MDR group, in which Gram-negative bacteria accounted for the highest proportion(58.33%); Gram-positive bacteria and fungi accounted for 22.62% and 19.05% respectively. There were significant differences between MDR group and NMDR group in COPD classification, hospitalization length, mechanical ventilation treatment, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes mellitus(all P<0.05). Multivariate logistic regression analysis showed that mechanical ventilation, invasive manipulation, glucocorticoid use, long-term use of antibiotics and history of diabetes were independent risk factors for multidrug-resistant bacterial infection(P<0.05). Conclusion Gram-negative bacteria were predominant in COPD with multidrug-resistant bacterial infection in lower respiratory tract. Mechanical ventilation, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes were independent risk factors for the infection. It is suggested that sensitive drugs should be selected according to the types of pathogens and effective measures should be taken to deal with the risk factors.
引文
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[9] LIU Fuping.Clinical study of risk factors of secondary pulmonary fungal infection in elderly patients with chronic obstructive pulmonary disease[J].China Mod Med,2015,22(26):26-28.(in Chinese) 刘福平.老年慢性阻塞性肺疾病继发肺真菌病危险因素的临床研究[J].中国当代医药,2015,(26):26-28.
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[11] LI Juan,LIU Pian,WANG Kaijin,et al.Pathogenic bacteria distribution and drug sensitivity test for AECOPD patients with respiratory tract infection[J].J Clin Pulmon Med,2016,21(11):2003-2005.(in Chinese) 李娟,刘翩,王开金,等.慢性阻塞性肺疾病急性加重期呼吸道感染的病原菌分布和药敏分析[J].临床肺科杂志,2016,21(11):2003-2005.
[12] ZOU Dongxia,JI Zhaofang,ZHANG Lamei,et al.Risk factors of pulmonary fungal infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure[J].Pract Geriatr,2017,31(12):1138-1144.(in Chinese) 邹冬侠,纪兆放,张腊梅,等.老年慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭病人肺部真菌感染危险因素分析[J].实用老年医学,2017,31(12):1138-1144.
[13] WEI Xinsu,QIN Yong,CUI Haidong,et al.Pathogenic bacteria distribution and risk factors of lower respiratory tract infection in patients with AECOPD in Xinjiang Akesu area[J].Occupat Health,2017,33(12):1647-1650.(in Chinese) 魏新素,秦勇,崔海东,等.新疆阿克苏地区AECOPD患者下呼吸道感染病原菌分布及其危险因素[J].职业与健康,2017,33(12):1647-1650.
[14] LI Xuezhong,YANG Qingcheng,ZHANG Xiangdong,et al.Exploration of etiology and related factors of multidrug-resistant bacterial infection in elderly patients with stroke associated pneumonia[J].Chin J Nosocom Infect,2017,27(7):1521-1523.(in Chinese) 李学仲,杨清成,张向东,等.老年脑卒中相关性肺炎患者多药耐药菌感染病原学及相关因素探讨[J].中华医院感染学杂志,2017,27(7):1521-1523.
[15] GONG Feng,YE Ruihai,LIN Hai.Risk factors for pulmonary fungal infections in patients with chronic obstructive pulmonary disease[J].Chin J Nosocom Infect,2014,24(13):3237-3239.(in Chinese) 龚峰,叶瑞海,林海.慢性阻塞性肺疾病患者肺部真菌感染危险因素研究[J].中华医院感染学杂志,2014,24(13):3237-3239.
[16] XIE Zhaoyun,XIONG Yun,SUN Jing,et al.Analysis of risk factors for multiple drug resistant bacterial infections in chronic obstructive pulmonary disease[J].Tianjin Med J,2016,44(6):744-747.(in Chinese) 谢朝云,熊芸,孙静,等.慢性阻塞性肺疾病多重耐药菌感染的危险因素分析[J].天津医药,2016,44(6):744-747.
[17] GU Qianqian,WANG Bin,ZHAO Yuanping,et al.Pathogenic characteristics of an infection with a multidrug-resistant bacterium in patients with chronic heart failure and factors influencing that infection[J].Chin J Pathogen Biol,2018,13(4):413-416.(in Chinese) 谷倩倩,王斌,赵元平,等.伴多重耐药菌感染的慢性心力衰竭患者病原学特点及影响因素分析[J].中国病原生物学杂志,2018,13(4):413-416.
[2] PEI Qi,LIU Xiao,LIU Jingyu,et al.Clinical characteristics of multidrug-resistant bacteria causing lower respiratory tract infections in patients with severe chronic obstructive disease and etiological analysis[J].Chin J Nosocom Infect,2014,24(5):1152-1154.(in Chinese) 裴琦,刘霄,刘敬禹,等.重度慢性阻塞性肺疾病患者下呼吸道多药耐药菌感染的临床特点及病原学分析[J].中华医院感染学杂志,2014,24(5):1152-1154.
[3] LIANG Ru,CHEN Wen.Analysis of the risk factors of multidrug-resistant infection in elderly patients with chronic obstructive pulmonary disease[J].Acta Med Sinica,2017,30(5):55-58.(in Chinese) 梁汝,陈韫.老年慢阻肺患者多重耐药菌感染相关危险因素分析[J].华夏医学,2017,30(5):55-58.
[4] Chinese Journal of Respiratory Diseases Chronic Obstructive Pulmonary Diseases Group.Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease(revised edition 2013)[J].Chin J Tubercul Respirat Dis,2013,36(4):255-264.(in Chinese) 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[5] GU Yanying,WU Xiaoyan,LI Xiaosi.The risk factors of multi-resistant bacteria infection in senile psychiatric patients[J].Chin J Microecol,2016,28(4):462-464.(in Chinese) 顾琰颖,吴晓燕,李小四.老年期精神病患者多重耐药菌感染的危险因素分析[J].中国微生态学杂志,2016,28(4):462-464.
[6] QIN Yong,WEI Xinsu,PENG Yingdong,et al.Bacterial infection and drug resistance among AECOPD patients and their risk factors[J].Agricul Reclam Med,2016,38(1):54-58.(in Chinese) 秦勇,魏新素,彭英东,等.慢阻肺患者下呼吸道感染病原菌分析及危险因素研究[J].农垦医学,2016,38(1):54-58.
[7] YU Hairong,MENG Hao,XU Liuliu,et al.Sputum etiology and drug sensitivity tests for patients with lower respiratory infection on acute exacerbation chronic obstructive pulmonary disease in Huaihai region[J].South Defense Med,2014,16(5):499-501.(in Chinese) 于海容,孟浩,许柳柳,等.淮海地区慢性阻塞性肺病急性加重期合并下呼吸道感染患者的病原菌特点及药敏分析[J].东南国防医药,2014,16(5):499-501.
[8] LIANG Xinmei,LIANG Kecheng,LU Cuimei,et al.Pathogenic bacteria distribution and drug resistance in AECOPD patients[J].J Clin Pulmon Med,2015,20(3):446-449.(in Chinese) 梁新梅,梁克诚,卢翠梅,等.慢性阻塞性肺部疾病急性加重期病原菌分布及耐药性研究[J].临床肺科杂志,2015,20(3):446-449.
[9] LIU Fuping.Clinical study of risk factors of secondary pulmonary fungal infection in elderly patients with chronic obstructive pulmonary disease[J].China Mod Med,2015,22(26):26-28.(in Chinese) 刘福平.老年慢性阻塞性肺疾病继发肺真菌病危险因素的临床研究[J].中国当代医药,2015,(26):26-28.
[10] XU Lingbin,XIONG Jie,SUN Li,et al.Risk factors of pulmonary fungal infections in patients with acute exacerbation of chronic obstructive pulmonary diseases[J].Chin J Nosocom Infect,2013,23(3):529-531.(in Chinese) 徐灵彬,熊洁,孙莉,等.老年慢性阻塞性肺疾病急性加重患者合并肺部真菌感染危险因素分析[J].中华医院感染学杂志,2013,23(3):529-531.
[11] LI Juan,LIU Pian,WANG Kaijin,et al.Pathogenic bacteria distribution and drug sensitivity test for AECOPD patients with respiratory tract infection[J].J Clin Pulmon Med,2016,21(11):2003-2005.(in Chinese) 李娟,刘翩,王开金,等.慢性阻塞性肺疾病急性加重期呼吸道感染的病原菌分布和药敏分析[J].临床肺科杂志,2016,21(11):2003-2005.
[12] ZOU Dongxia,JI Zhaofang,ZHANG Lamei,et al.Risk factors of pulmonary fungal infection in elderly patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure[J].Pract Geriatr,2017,31(12):1138-1144.(in Chinese) 邹冬侠,纪兆放,张腊梅,等.老年慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭病人肺部真菌感染危险因素分析[J].实用老年医学,2017,31(12):1138-1144.
[13] WEI Xinsu,QIN Yong,CUI Haidong,et al.Pathogenic bacteria distribution and risk factors of lower respiratory tract infection in patients with AECOPD in Xinjiang Akesu area[J].Occupat Health,2017,33(12):1647-1650.(in Chinese) 魏新素,秦勇,崔海东,等.新疆阿克苏地区AECOPD患者下呼吸道感染病原菌分布及其危险因素[J].职业与健康,2017,33(12):1647-1650.
[14] LI Xuezhong,YANG Qingcheng,ZHANG Xiangdong,et al.Exploration of etiology and related factors of multidrug-resistant bacterial infection in elderly patients with stroke associated pneumonia[J].Chin J Nosocom Infect,2017,27(7):1521-1523.(in Chinese) 李学仲,杨清成,张向东,等.老年脑卒中相关性肺炎患者多药耐药菌感染病原学及相关因素探讨[J].中华医院感染学杂志,2017,27(7):1521-1523.
[15] GONG Feng,YE Ruihai,LIN Hai.Risk factors for pulmonary fungal infections in patients with chronic obstructive pulmonary disease[J].Chin J Nosocom Infect,2014,24(13):3237-3239.(in Chinese) 龚峰,叶瑞海,林海.慢性阻塞性肺疾病患者肺部真菌感染危险因素研究[J].中华医院感染学杂志,2014,24(13):3237-3239.
[16] XIE Zhaoyun,XIONG Yun,SUN Jing,et al.Analysis of risk factors for multiple drug resistant bacterial infections in chronic obstructive pulmonary disease[J].Tianjin Med J,2016,44(6):744-747.(in Chinese) 谢朝云,熊芸,孙静,等.慢性阻塞性肺疾病多重耐药菌感染的危险因素分析[J].天津医药,2016,44(6):744-747.
[17] GU Qianqian,WANG Bin,ZHAO Yuanping,et al.Pathogenic characteristics of an infection with a multidrug-resistant bacterium in patients with chronic heart failure and factors influencing that infection[J].Chin J Pathogen Biol,2018,13(4):413-416.(in Chinese) 谷倩倩,王斌,赵元平,等.伴多重耐药菌感染的慢性心力衰竭患者病原学特点及影响因素分析[J].中国病原生物学杂志,2018,13(4):413-416.