伴多重耐药菌感染的慢性心力衰竭患者病原学特点及影响因素分析

Pathogenic characteristics of an infection with a multidrug-resistant bacterium in patients with chronic heart failure and factors influencing that infection

目的分析慢性心力衰竭伴多重耐药菌感染患者病原学特点及其影响因素。方法选择2016年1月至2017年6月本院收治的278例慢性心力衰竭患者作为研究对象,根据是否分离出多重耐药菌将患者分为多重耐药组(MDR组,150例)和非多重耐药组(NMDR组,128例),采用全自动细菌鉴定仪鉴定病原菌,采用K-B纸片扩散法检测病原菌的耐药性,并分析多重耐药菌感染的影响因素。结果多重耐药组150例患者共分离出165株病原菌,其中革兰阴性菌114株,占69.09%;革兰阳性菌46株,占27.88%;真菌5株,占3.03%。分离株铜绿假单胞菌对多种抗菌药物耐药,耐药率较高的有头孢呋辛(80.65%)、头孢哌酮/舒巴坦(77.42%)、青霉素(77.42%)和左氧氟沙星(77.42%);鲍曼不动杆菌耐药率较高的药物有左氧氟沙星(88.10%)、头孢呋辛(83.33%)、青霉素(73.81%)和氨曲南(73.81%);大肠埃希菌耐药率较高的药物有头孢呋辛(80.00%)、青霉素(75.00%)和左氧氟沙星(75.00%)。金黄色葡萄球菌对多种抗菌药物耐药,耐药率较高的有青霉素(100.00%)、红霉素(86.21%)和头孢呋辛(86.21%);肺炎链球菌耐药率较高的药物有青霉素(81.82%)、庆大霉素(81.82%)、红霉素(81.82%)和环丙沙星(81.82%);表皮葡萄球菌耐药率较高的药物有头孢呋辛(83.33%)、青霉素(83.33%)、庆大霉素(83.33%)和环丙沙星(83.33%)。多因素Logistic回归分析,住院时间、NYHA分级、侵袭性操作、预防性抗菌药物的使用以及糖尿病史是慢性心力衰竭伴多重耐药菌感染的独立危险因素。结论慢性心力衰竭患者发生的多重耐药菌感染以革兰阴性菌为主,其与住院时间、NYHA分级、侵袭性操作、预防性抗菌药物的使用以及糖尿病史密切相关。因此应根据细菌的药物敏感性及感染发生的影响因素制定有效的预防措施,控制和减少慢性心力衰竭患者多重耐药菌感染的发生。

Objective To examine the pathogenic characteristics of an infection with a multidrug-resistant bacterium in patients with chronic heart failure and factors influencing that infection. Methods Subjects were 278 patients with chronic heart failure who were treated at this Hospital from January 2016 to June 2017.Patients were divided into those infected with a multidrug-resistant bacterium（150 patients with an infection）and those not infected with a multidrug-resistant bacterium（128 patients without an infection）depending on whether or not multidrug-resistant bacteria were isolated.The pathogen was identified by an automated microbe identification system,and the drug resistance of pathogens was determined using the K-B disk diffusion method.Factors influencing the multidrug resistance of pathogens were analyzed.Results One hundred and sixty-five strains of pathogens were isolated from 150 infected patients.Of those,114（69.09%）were Gram-negative bacteria and 46（27.88%）were Gram-positive bacteria.The 165 strains of pathogens included 5 strains of fungi（3.03%）.Pseudomonas aeruginosa was resistant to many antimicrobials.It was most resistant to cefuroxime（80.65%）,cefoperazone/shubatan（77.42%）,penicillin（77.42%）,and levofloxacin（77.42%）.Acinetobacter baumannii was most resistant to levofloxacin（88.10%）,cefuroxime（83.33%）,penicillin（73.81%）,and aztreonam（73.81%）.Escherichia coli was most resistant to cefuroxime（80%）,penicillin（75%）,and levofloxacin（75%）.Staphylococcus aureus was resistant to many antimicrobials.It was most resistant to penicillin（100%）,eryth-romycin（86.21%）,and cefuroxime（86.21%）.Streptococcus pneumonia was most resistant to penicillin（81.82%）,gentamicin（81.82%）,erythromycin（81.82%）,and ciprofloxacin（81.82%）.Staphylococcus epidermidis was most resistant to cefuroxime（83.33%）,penicillin（83.33%）,gentamicin（83.33%）,and ciprofloxacin（83.33%）.The duration of hospitalization,the NYHA class of heart failure,undergoing an invasive procedure,prophylactic use of antimicrobials,and a history of diabetes were independent risk factors for chronic heart failure and an infection with a multidrug-resistant bacterium. Conclusion Patients with chronic heart failure and an infection with a multidrug-resistant bacterium were mainly infected with Gram-negative bacteria.An infection with a multidrug-resistant bacterium was closely related to the duration of hospitalization,the NYHA class of heart failure,undergoing an invasive procedure,prophylactic use of antibiotics,and a history of diabetes.Effective control measures should be devised and implemented based on the results of drug sensitivity testing and risk factors for an infection.