重度慢性阻塞性肺疾病亚胺培南治疗后继发二重感染危险因素分析

Risk Factors of Superinfection Following Imipenem Therapy in Hospitalized Patients with Acute Exacerbations of Severe Chronic Obstructive Pulmonary Disease

目的:分析亚胺培南治疗重度慢性阻塞性肺疾病(COPD)继发二重感染的危险因素。方法:记录重度COPD经亚胺培南治疗3d以上者的临床资料,分析其与二重感染的关系。结果:1年半观察期内在呼吸重症监护室入选51例患者,亚胺培南治疗后,88.2%的患者病情明显改善。39例具有确切细菌学结果的患者中二重感染发生率为30.8%。二重感染的发生与血pH值(OR=0.004,P=0.48)、先前用过头孢菌素(OR=24.314,P=0.019)以及亚胺培南疗程(OR=2.473,P=0.013)有关。结论:酸中毒、先前用过头孢菌素以及亚胺培南疗程长均增加重度COPD住院患者二重感染机会。

Objective： To explore any clinical factors which determine the risk of superinfection after imipenem treatment in patients with acute exacerbations of severe chronic obstructive pulmonary （COPD）. Methods： A prospective observational study was conducted in a 5-bed respiratory intensive care unit of a Chinese university hospital. The associations between the risk of superinfection and potential clinical factors were analyzed by logistic regression. Results： Fifty-one patients with acute exacerbations of severe COPD who were hospitalized and treated with imipenem for more than three days were enrolled during 1.5 years. Forty-five out of 51 patients （88.2%） had their symptoms and signs improved after imipenem treatment. Superinfections were developed in 12 patients （30.8%, 12 out of 39 patients with definite bacteriologic responses）. The risk of superinfection was associated with blood pH （OR=0. 004, P=0.48）, previous cefalosporines treatment （OR=24. 314, P=0. 019）, and period of imipenem treatment（OR=2. 473, P=0. 013）. Conclusion： The risk of superinfection following imipenem treatment in hospitalized patients with acute exacerbations of severe COPD was very high. Acidosis, previous cephalosporines treatment and longer period of imipenem treatment all increase the risk of superinfection.