呼吸与危重症医学科革兰阴性杆菌感染的临床特征与耐药现状:2018年——2021年的回顾性研究

Clinical characteristics and current drug resistance of Gram-negative bacterial infections in department of respiratory and critical care medicine:a retrospective study from 2018 to 2021

目的 探讨革兰阴性杆菌(Gram-negative bacillus,GNB)感染患者的临床特征及药敏结果,评价其感染发生相关的危险因素,为临床防治医院内获得性感染提供理论依据。方法 回顾性收集我院2018年1月—2021年9月呼吸与危重症医学科181例GNB感染患者的完整病历资料,根据对碳青霉烯类药物的敏感性不同分为耐药组(Carbapenem-resistant Gram-negative bacillus,CR-GNB)和敏感组(Carbapenem-sensitive Gramnegative bacillus,CS-GNB)进行统计学分析。结果 共检出GNB 238株,其中CR-GNB 108株,CS-GNB 130株;以鲍曼不动杆菌最常见,其次为铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌和黏质沙雷菌。单因素分析显示合并有心脏疾病和脑血管疾病、接受有创机械通气、深静脉置管及留置尿管、低蛋白血症、肾功能不全、感染前接触替加环素、碳青霉烯类、万古霉素、多黏菌素以及联合应用抗菌药物是CR-GNB感染发生的危险因素,其中低蛋白血症和深静脉置管是CR-GNB感染发生的独立危险因素。CR-GNB对头孢吡肟、头孢他啶、左氧氟沙星和环丙沙星耐药率最高,分别为88.0%、88.0%、86.1%和75.0%;对头孢呋辛、阿米卡星、头孢曲松、庆大霉素和复方新诺明耐药率较低,对头孢他啶阿维巴坦耐药率最低(3.7%)。除四环素、替加环素、头孢呋辛、多黏菌素、头孢唑林和氨苄西林外,CR-GNB组对其他抗菌药的耐药率均高于CS-GNB组,差异具有统计学意义(P<0.05)。CR-GNB组住院期间患者全因病死率(42.4%)明显高于CS-GNB组(6.3%),差异具有统计学意义(P<0.05)。结论 CR-GNB感染所带来的疾病负担越来越重,对住院患者的预后产生严重影响。抗生素的耐药性增加导致抗菌治疗效果不佳。因此,应早期识别感染的高危人群,合理谨慎的应用抗菌药物治疗方案,从而达到降低感染的病死率、改善住院患者预后的目的。

Objective To investigate the clinical characteristics and drug sensitivity of patients with Gramnegative bacilli infection,and evaluate the risk factors related to infection,so as to provide a theoretical basis for clinical prevention and treatment of hospital-acquired infection.Methods The complete medical records of 181 patients with Gram-negative bacilli infection in the Department of Respiratory and Critical Care Medicine of Beijing Anzhen Hospital from January 2018 to September 2021 were retrospectively collected.They were divided into a Carbapenem-resistant Gram-negative bacillus(CR-GNB)group and a Carbapenem-sensitive Gram-negative bacillus(CS-GNB)group according to their different sensitivities to carbapenems.Results A total of 238 strains of Gram-negative bacilli were detected,including 108 strains of CR-GNB and 130 strains of CS-GNB.Acinetobacter baumannii was the most common,followed by Pseudomonas aeruginosa,Klebsiella pneumoniae,Enterobacter cloacae,Escherichia coli and Serratia marcescens.Univariate analysis showed that the risk factors of CR-GNB infection were heart disease and cerebrovascular disease,receiving invasive mechanical ventilation,deep venous catheterization and indwelling catheter,hypoproteinemia,renal insufficiency,pre-infection exposure to tigecycline,carbapenems,vancomycin,polymyxin,and combined use of antibiotics.Hypoproteinemia and deep venous catheterization were independent risk factors for CR-GNB infection.The resistance rates of CR-GNB to cefepime,ceftazidime,levofloxacin and ciprofloxacin were 88.0%,88.0%,86.1%and 75.0%,respectively.The resistance rate to cefuroxime,amika,ceftriaxone,gentamicin and cotrimoxazole was low,and the resistance rate to ceftazidime avibactam was the lowest(3.7%).Except tetracycline,tigecycline,cefuroxime,polymyxin,cefazolin and ampicillin,the drug resistance rates of CR-GNB group to other antibacterial drugs were higher than those of CS-GNB group,and the differences were statistically significant(P<0.05).The all-cause mortality in CR-GNB group(42.4%)was significantly higher than that in CS-GNB group(6.3%),and the difference was statistically significant(P<0.05).Conclusions The disease burden caused by CR-GNB infection is becoming heavier and heavier,which has a serious impact on the prognosis of hospitalized patients.The increase of antibiotic resistance leads to poor efficacy of antimicrobial therapy.Therefore,early identification of high-risk groups of infection and reasonable and prudent application of antimicrobial therapy can achieve the purpose of reducing the mortality of infection and improving the prognosis of hospitalized patients.