慢性心力衰竭伴多重耐药菌感染的临床观察

Correlation Research on Clinical Characteristics of Chronic Heart Failure with Multi-drug Resistant Infections and Related Risk Factors of Chronic Heart Failure Combined with Multi-drug Resistant Infections

目的探讨慢性心力衰竭(CHF)伴多重耐药菌感染的临床特点及与相关危险因素的关系。方法选取邯郸市中心医院进行治疗的CHF患者130例,按照是否出现多重耐药菌感染分为多重耐药组(MR组)和非多重耐药组(NMR组),采用药敏试验耐药率情况,检测标本病原菌分布,分析相关危险因素。结果 76例CHF伴多重耐药菌感染患者中呼吸道感染有35例占46.05%,尿路感染23例占30.26%,肠道感染12例占15.79%,口腔感染4例占5.26%,穿刺感染2例占2.63%;多因素Logistic回归分析显示,糖尿病史、留置尿管、机械通气、使用抗生素、免疫抑制剂以及NYHA分级为CHF伴多重耐药菌感染的危险因素;76例CHF伴多重耐药菌感染患者共检出91株病原菌,其中革兰阴性菌为63株占69.23%,革兰阳性菌为25株占27.47%,真菌3株占3.30%。结论 CHF伴多重耐药菌感染以革兰阴性菌居多,其与糖尿病史、机械通气、留置尿管、药物因素以及NYHA分级有关。

Objective To investigate the clinical characteristics of chronic heart failure with multiple drug_resistant infections and its relationship with risk factors.Methods 130 patients of CHF were chosen from Handan Central Hospital.They were divided into mul-tidrug_resistant group （MR group ） and non_multidrug_resistant group （NMR group ） according to whether there had been multiple drug_resistant infections.Antimicrobial susceptibility test was conducted to detect the pathogens distribution of samples by drug resis-tance rate ,and relevant risk factors were analyzed.Results Out of 76 cases ,there were 35 cases of CHF with multi_drug_resistant in-fections had respiratory tract infection which accounted for 46.0% ,23 urinary tract infection cases （30.26% ） ,12 intestinal infec-tion cases （15.79% ） ,4 oral infections cases （5.26% ） ,and 2 puncture infection cases （2.63% ）;multivariate logistic regression analysis showed that diabetes mellitus ,indwelling catheter ,mechanical ventilation ,use of antibiotics ,immunosuppressant and NYHA class were risk factors of CHF with multi_drug resistant infections;A total of 91 pathogenic strains were detected from the 76 cases of CHF with multiple drug_resistant infections ,including 63 strains of Gram_negative bacteria that accounted for 69.23% ,25 strains of Gram_positive bacteria that accounted for 27.47% ,and 3 strains of fungi that accounted for 3.30% .Conclusions Among CHF with multi_drug resistant infections ,Gram_negative bacteria was in the majority and related with diabetes mellitus ,mechanical ventilation , indwelling catheter ,drug_related factors ,and NYHA class.