肺部感染患者多药耐药菌耐药性与转归
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摘要
目的探讨肺部感染患者多药耐药菌(MDRO)耐药性与转归,为MDRO肺部感染的治疗提供参考。方法选取2017年1-12月医院收治的肺部感染患者200例为研究对象,采集痰液标本行细菌培养菌株鉴定及药物敏感试验,同时给予敏感抗菌药物治疗,观察患者治疗转归。结果178例患者痰液培养出病原菌,阳性率为89.00%,其中132例非MDRO感染、46例MDRO感染;46例MDRO患者中42例为单一病原菌感染,4例为多重病原菌感染。46例MDRO感染患者检出MDRO 50株,其中革兰阴性菌41株占82.00%,以鲍氏不动杆菌、肺炎克雷伯菌为主;革兰阳性菌9株占18.00%,均为金黄色葡萄球菌。MDRO金黄色葡萄球菌对青霉素、头孢唑林、苯唑青霉素、哌拉西林/他唑巴坦、红霉素完全耐药,对亚胺培南、环丙沙星、左氧氟沙星、庆大霉素、四环素耐药率均>70%,对万古霉素敏感;MDRO革兰阴性菌对一代头孢和青霉素类药物多数完全耐药,对亚胺培南耐药率相对低;MDRO感染患者恶化率为15.22%(7/46)高于非MDRO感染患者(P=0.013)。结论肺部感染患者MDRO感染率较高,主要以革兰阴性菌为主,对抗菌药物广泛耐药,MDRO感染患者不良转归率明显增高。
OBJECTIVE To investigate the drug resistance of multidrug-resistant organism(MDRO)and prognosis in patients with pulmonary infection,so as to provide reference for prevention and treatment of patients with pulmonary infection caused by MDRO.METHODS 200 patients with pulmonary infection treated in the hospital from Jan.2017-Dec.2017 were enrolled in the study,sputum samples were collected for bacterial culture,bacterial strain identification and drug sensitive test,and meanwhile the treatment with sensitive antimicrobial agents was given and the outcome of treatment in patients with pulmonary infection was observed.RESULTS Pathogens were isolated from the sputum samples of 178 patients,with a positive rate of 89.00%,among which 132 cases were non-MDRO infection and 46 cases were MDRO infection.In cases with MDRO infection,42 cases were single infection,and 4 cases were multiple infection.A total of 50 MDRO strains were detected from the 46 MDRO-infected patients,among which there were 41 strains of gram-negative bacteria,accounting for 82.00%,dominated by Acinetobacter baumannii and Klebsiella pneumoniae,and 9 strains of gram-positive bacteria,accounting for18.00%,dominated by Pseudomonas aeruginosa.Staphylococcus aureus MDRO strains were completely resistance to penicillin,cefazolin sodium,benzazole penicillin,piperacillin/triazolamide and erythromycin,and the resistance rates to imipenem,ciprofloxacin,levofloxacin,gentamicin and tetracycline were all>70%,but they were susceptible to vancomycin.Most of gram-negative MDRO bacteria were completely resistant to the first generation of cephalosporins and penicillins,while their resistance rate to imipenem was relatively low.The deterioration rate of patients with MDRO infection was 15.22%(7/46),significantly higher than that of patients with non-MDRO infection(P=0.013).CONCLUSION MDRO infection rate is high in patients with pulmonary infection,with gram-negative bacteria as the main pathogens,which have wide-spectrum resistance to antimicrobial agents.MDRO infection can increase the incidence of adverse outcomes in patients.
OBJECTIVE To investigate the drug resistance of multidrug-resistant organism(MDRO)and prognosis in patients with pulmonary infection,so as to provide reference for prevention and treatment of patients with pulmonary infection caused by MDRO.METHODS 200 patients with pulmonary infection treated in the hospital from Jan.2017-Dec.2017 were enrolled in the study,sputum samples were collected for bacterial culture,bacterial strain identification and drug sensitive test,and meanwhile the treatment with sensitive antimicrobial agents was given and the outcome of treatment in patients with pulmonary infection was observed.RESULTS Pathogens were isolated from the sputum samples of 178 patients,with a positive rate of 89.00%,among which 132 cases were non-MDRO infection and 46 cases were MDRO infection.In cases with MDRO infection,42 cases were single infection,and 4 cases were multiple infection.A total of 50 MDRO strains were detected from the 46 MDRO-infected patients,among which there were 41 strains of gram-negative bacteria,accounting for 82.00%,dominated by Acinetobacter baumannii and Klebsiella pneumoniae,and 9 strains of gram-positive bacteria,accounting for18.00%,dominated by Pseudomonas aeruginosa.Staphylococcus aureus MDRO strains were completely resistance to penicillin,cefazolin sodium,benzazole penicillin,piperacillin/triazolamide and erythromycin,and the resistance rates to imipenem,ciprofloxacin,levofloxacin,gentamicin and tetracycline were all>70%,but they were susceptible to vancomycin.Most of gram-negative MDRO bacteria were completely resistant to the first generation of cephalosporins and penicillins,while their resistance rate to imipenem was relatively low.The deterioration rate of patients with MDRO infection was 15.22%(7/46),significantly higher than that of patients with non-MDRO infection(P=0.013).CONCLUSION MDRO infection rate is high in patients with pulmonary infection,with gram-negative bacteria as the main pathogens,which have wide-spectrum resistance to antimicrobial agents.MDRO infection can increase the incidence of adverse outcomes in patients.
引文
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[2] Crum-Cianflone NF,Sullivan E,Ballon-Landa G.Fecal microbiota transplantation and successful resolution of multidrug-resistant-organism colonization[J].J Clin Microbiol,2015,53(6):1986-1989.
[3] Levitt GA.Infection control for MRSA in a psychiatric hospital[J].Gen Hosp Psychiatry,2014,36(4):422-424.
[4] Maechler F,Pena Diaz LA,Schroder C,et al.Prevalence of carbapenem-resistant organisms and other gram-negative MDRO in German ICUs:first results from the national nosocomial infection surveillance system(KISS)[J].Infection,2015,43(2):163-168.
[5] McKinnell JA,Miller LG,Singh R,et al.Prevalence of and factors associated with multidrug-resistant organism(MDRO)colonization in 3nursing homes[J].Infect Control Hosp Epidemiol,2016,37(12):1485-1488.
[6]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].中华结核和呼吸杂志,1999,14(4):160-161.
[7] Woodhead M,Blasi F,Ewig S,et al.Guidelines for the management of adult lower respiratory tract infections-full version[J].Clin Microbiol Infect,2011,17(Suppl 6):E1-59.
[8] Poirel L,Jayol A,Nordmann P.Polymyxins:antibacterial activity,susceptibility testing,and resistance mechanisms encoded by plasmids or chromosomes[J].Clin Microbiol Rev,2017,30(2):557-596.
[9] Ceccon M,Mologni L,Giudici G,et al.Treatment efficacy and resistance mechanisms using the second-generation ALK inhibitor AP26113in human NPM-ALK-positive anaplastic large cell lymphoma[J].Mol Cancer Res,2015,13(4):775-783.
[10] Xu ZQ,Flavin MT,Flavin J.Combating multidrug-resistant gram-negative bacterial infections[J].Expert Opin Investig Drugs,2014,23(2):163-182.
[11] Mehrad B,Clark NM,Zhanel GG,et al.Antimicrobial resistance in hospital-acquired gram-negative bacterial infections[J].Chest J,2015,147(5):1413-1421.
[12]黄伟,万献尧.2013年重症医学回顾与展望[J].中华危重病急救医学,2014,26(1):3-10.