慢性阻塞性肺疾病机械通气患者抗生素相关性腹泻危险因素及病原菌分析

Analysis of the risk factors and pathogenic bacteria of antibiotic associated diarrhea in patients with chronic obstructive pulm onary disease using mechanical ventilation

目的分析本院慢性阻塞性肺疾病(慢阻肺)机械通气患者抗生素相关性腹泻(antibiotic associated diarrhea,AAD)的危险因素及病原菌。方法回顾性分析2013年1月至2016年12月本院165例慢阻肺机械通气合并AAD患者的一般情况、临床表现、病原菌分布特点及其耐药性,观察抗生素应用种类、疗程与AAD的关系。结果 165份样本共分离出病原菌171株,其中革兰阴性菌133株(77.78%),以大肠埃希菌为主;革兰阳性菌32株(18.71%),以粪肠球菌为主;真菌6株(3.51%),以白色念珠菌为主。患者年龄越大、联合使用广谱抗生素的种类越多、抗生素使用时间越长,AAD的发生率越高(P<0.05);大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌等多药耐药革兰阴性菌对常用抗生素均产生了不同程度的耐药性。结论严格掌握抗生素使用指征、合理选用抗生素、尽量减少侵袭性操作能够有效降低AAD的发生。

Objective To analyze the risk factors and pathogenic bacteria in patients of antibiotic associated diarrhea（AAD） with chronic obstructive pulmonary disease（COPD） in our hospital. Method 165 cases of hospitalized patients with COPD combined with AAD in our hospital were selected from January 2013 to December 2016, the general condition, clinical manifestation and distribution and drug resistance of pathogenic bacteria were analyzed retrospectively, the relationship between the species and antibiotic dosage and duration of treatment with AAD were observed. Result 171 strains of pathogenic bacteria were isolated from 165 samples, in which 133 strains（77.78%） were Gram-negative bacteria and Escherichia coli were the most; 32 strains（18.71%） of Gram-positive bacteria and Enterococcus faecalis were the most; 6 strains（3.51%） of fungi and Candida albicans was the most. The older the patient, the more widely used antibiotics and the longer the duration of antibiotic treatment, the higher the incidence of AAD（P〈0.05）. Multidrug-resistant Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, baumanii, Pseudomonas aeruginosa had different degrees of resistance to common antibiotics. Conclusion Strictly grasp of the indications of antibiotic use, rational use of antibiotics and minimize invasive operation can effectively reduce the occurrence of diarrhea.