某院获得性肺部多药耐药菌感染状况研究

Prevalence of hospital-acquired pulmonary infections caused by multidrug-resistant organisms

目的调查医院获得性肺炎(HAP)患者中多药耐药菌(MRB)的感染状况,探讨其影响因素,为临床提供参考依据。方法选取2015年1月-2016年12月医院呼吸内科收治入院的283例HAP患者为研究对象,采集患者痰标本,分析感染病原菌分布及耐药性,采用单因素及多因素logistics回归分析MRB感染发生的独立影响因素。结果 283份HAP患者标本共检出113株MRB,检出率为39.9%,其中革兰阴性菌82株(72.6%),革兰阳性菌31株(27.4%);革兰阴性MRB中鲍氏不动杆菌对氨苄青霉素的耐药率最高,其次是头孢他啶和哌拉西林;革兰阳性MRB中肺炎链球菌对青霉素的耐药率最高,其次是哌拉西林和克林霉素;年龄≥65岁、合并脑血管疾病、COPD的发生率、抗菌药物应用≥2种、气管插管、机械通气、深静脉置管、留置胃管患者的MRB感染率升高(P<0.05);多因素logistic回归分析结果表明脑血管疾病史、抗菌药物应用≥2种、机械通气、深静脉置管是患者发生MRB感染的相关因素(P<0.05)。结论 HAP患者中MRB感染率较高,耐药状况较为严峻,临床应针对MRB感染的危险因素加以预防。

OBJECTIVE To investigate the prevalence of multidrug-resistant organisms（MDROs）infections in patients with hospital-acquired pneumonia（HAP）and explore the influencing factors so as to provide guidance for clinical treatment.METHODS A total of 283 patients with HAP who were treated in department of respiratory medicine from Jan 2015 to Dec 2016 were recruited as the study objects,the sputum specimens were collected from the patients,the distribution and drug resistance of pathogens causing the infections were observed,and the univariate analysis and multivariate logistic regression analysis were performed for the independent influencing factors for the MDROs infections.RESULTS Totally 113 strains of MDROs were isolated from the specimens that were obtained from the 283 patients with HAP,with the isolation rate 39.9%,82（72.6%）of which were gramnegative bacteria,and 31（27.4%）were gram-positive bacteria.Among the gram-negative MDROs,the Acinetobacter baumannii was most highly resistant to ampicillin,followed by ceftazidime and piperacillin.among the gram-positive MDROs,the Streptococcus pneumoniae was most highly resistant penicillin,followed by piperacillin and clindamycin.The incidence of MDROs infections was increased in the patients with no less than 65 years of age,complication with cerebrovascular disease,COPD,use of no less than 2 types of antibiotics,endotracheal intubation,mechanical ventilation,deep venous catheterization and gastric tube indwelling（P〈0.05）.The result of multivariate logistic regression analysis indicated that the history of cerebrovascular disease,use of no less than 2 types of antibiotics,mechanical ventilation and deep venous catheterization were the related factors for the MDROs infection（P〈0.05）.CONCLUSION The incidence of MDROs infections is high in the patients with HAP,the strains are highly resistant to antibiotics,and it is necessary for the hospital to take the prevention measures according to the risk factors for the MDROs infections.