伴下呼吸道多重耐药菌感染的慢性阻塞性肺病患者病原菌分布及危险因素分析

Distribution of pathogens and risk factors in patients with chronic obstructive pulmonary disease with multiple respiratory tract infections

目的探讨伴下呼吸道多重耐药菌感染的慢性阻塞性肺病(COPD)患者病原菌分布及其危险因素。方法选取2017年1月至2018年6月我院收治的138例COPD伴下呼吸道感染患者作为研究对象,根据下呼吸道分泌物是否分离出多重耐药菌将患者分为多重耐药组(MDR组,71例)和非多重耐药组(NMDR组,67例)。采用全自动细菌鉴定仪对菌种进行鉴定,采用K-B纸片法进行药敏试验,并分析多重耐药菌感染的危险因素。结果多重耐药组患者共分离出84株病原菌,其中革兰阴性菌所占比例最高,为58.33%;革兰阳性菌与真菌分别占22.62%和19.05%。MDR组与NMDR组患者在COPD分级、住院时间、机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史方面差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示机械通气治疗、侵入性操作、使用糖皮质激素、长期使用抗菌药物及糖尿病史是多重耐药菌感染的独立危险因素(P<0.05)。结论COPD伴下呼吸道多重耐药菌感染病原菌以革兰阴性菌为主,机械通气治疗、侵入性操作、长期使用糖皮质激素、长期使用抗菌药物及糖尿病史是发生感染的独立危险因素。建议根据病原菌种类选择相应的敏感药物,并采取针对危险因素的有效措施。

Objective To investigate the distribution of pathogens and risk factors in patients with chronic obstructive pulmonary disease(COPD) and infection with multi drug resistant bacteria in lower respiratory tract. Methods 138 COPD patients with lower respiratory tract infection admitted to our hospital from January 2017 to June 2018 were selected as the study subjects. According to the isolation of multidrug-resistant bacteria from lower respiratory tract secretions, the patients were divided into multidrug-resistance group(MDR group, 71 cases) or non-multidrug-resistance group(NMDR group, 67 cases). The bacterial strains were identified using automatic bacterial identification instrument;drug sensitivity test was carried out using K-B disc method;the risk factors of multi-drug resistant bacterial infection were analyzed. Results A total of 84 pathogenic bacteria were isolated from the 71 patients in MDR group, in which Gram-negative bacteria accounted for the highest proportion(58.33%);Gram-positive bacteria and fungi accounted for 22.62% and 19.05% respectively. There were significant differences between MDR group and NMDR group in COPD classification, hospitalization length, mechanical ventilation treatment, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes mellitus(all P<0.05). Multivariate logistic regression analysis showed that mechanical ventilation, invasive manipulation, glucocorticoid use, long-term use of antibiotics and history of diabetes were independent risk factors for multidrug-resistant bacterial infection(P<0.05). Conclusion Gram-negative bacteria were predominant in COPD with multidrug-resistant bacterial infection in lower respiratory tract. Mechanical ventilation, invasive operation, long-term use of glucocorticoids, long-term use of antibiotics and history of diabetes were independent risk factors for the infection. It is suggested that sensitive drugs should be selected according to the types of pathogens and effective measures should be taken to deal with the risk factors.