慢阻肺患者感染鲍曼不动杆菌危险因素及耐药性分析

Analysis of risk factors and drug resistance of Acinetobacter baumannii in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)患者鲍曼不动杆菌(AB)感染的危险因素及耐药性,为COPD患者AB感染的防治提供理论依据。方法收集2012~2015年呼吸内科及RICU住院患者完整的临床资料,根据纳入排除标准选出308例痰培养结果为AB阳性的病例。对308例AB阳性病例及COPD合并AB阳性的91例病例进行耐药菌的筛选及耐药性测定分析。选取144例COPD患者中AB感染与AB未感染分别为72例进行病例-对照研究,采用二元Logistic回归分析与AB感染有关联的危险性因素。结果(1)与AB感染有统计学意义关联的危险性因素,单因素分析包括年龄、近期住院史、糖皮质激素及抗生素使用史、侵入性操作、慢性基础疾病、肺功能分级、急性加重频率有关(P<0.05);多因素Logistic回归分析有统计学意义关联的危险性因素为:侵入性操作(OR=3.725,95%CI=2.642~9.534)、近期住院史(OR=3.417,95%CI=1.412~8.515)、肺功能分级(OR=2.835,95%CI=1.565~8.623)、糖皮质激素使用史(OR=2.815,95%CI=1.328~9.045)、慢性基础疾病(OR=2.136,95%CI=1.023~8.146)、抗生素使用史(OR=2.326,95%CI=1.145~7.134)、急性加重频率(OR=2.823,95%CI=1.012~9.853)、年龄(OR=1.756,95%CI=1.003~7.035);(2)住院AB患者耐药实验结果显示对头孢吡肟耐药率最高(79.2%),替加环素耐药率最低(20.1%);(3)COPD患者感染的AB对亚胺培南(86.8%vs 59.4%)、头孢吡肟(93.4%vs 73.2%)、左氧氟沙星(82.4%vs 57.6%)、头孢哌酮舒巴坦(49.4%vs 29.0%)、替加环素(27.5%vs 17.1%)的耐药率更高,差异有统计学意义(P<0.05)。结论合并慢性基础疾病、侵入性诊疗操作、近期住院史、糖皮质激素及抗生素使用史、肺功能分级等是COPD患者AB感染的独立危险因素;与非COPD的AB下呼吸道感染患者相比,COPD患者AB感染对临床常用抗菌药物耐药率更高。

Objective To explore the risk factor of Acinetobacter baumannii(AB)infection and drug resistance in patients with chronic obstructive pulmonary disease(COPD)in order to provide a theoretical basis for treating AB infection in COPD patients.Methods The clinical data of inpatients treated during 2012 and 2015 were collected from departments of respiratory and respiratory intensive care unit,and 308 AB positive patients were selected according to the exclusion criteria.Drug-resistant bacteria and drug resistance were detected in 308 AB positive cases and 91 COPD cases with AB.A case control study was performed in 144 COPD patients,including 72 AB positive and 72 AB negative cases.The risk factors associated with AB infection were determined with binary logistic regression analysis.Results(1)Single factor analysis showed that age,recent history of hospitalization,history of glucocorticoid and antibiotics use,invasive operations,chronic diseases,classification of lung function and frequency of exacerbations were statistically significant(P<0.05).Multivariate Logistic regression showed that invasive operation(OR=3.725,95%CI=2.642-9.534),recent history of hospitalization(OR=3.417,95%CI=1.412-8.515),classification of lung function(OR=2.835,95%CI=1.012-9.853),history of glucocorticoid use(OR=2.815,95%CI=1.328-9.045),chronic disease(OR=2.136,95%CI=1.023-8.146),history of antibiotic use(OR=2.326,95%CI=1.145-7.134),frequency of exacerbations(OR=2.823,95%CI=1.012-9.853),age(OR=1.756,95%CI=1.003-7.035)were independent risk factors of AB infection(P<0.05).(2)Drug resistance tests of AB positive patients showed that cefepime had the highest drug resistance rate(79.2%),while tegacycline had the lowest drug resistance rate(20.1%).(3)Compared to non-COPD patients,COPD patients with AB had higher resistance rates to imipenem(86.8%vs 59.4%),cefepime(93.4%vs 73.2%),levofloxacin(82.4%vs 57.6%),cefoperazone sulbactam(49.4%vs 29.0%)and tegacycline(27.5%vs 17.1%).The differences were statistically significant(P<0.05).Conclusion Chronic diseases,invasive operation,recent history of hospitalization,history of glucocorticoid and antibiotic use and classification of lung function are independent risk factors for COPD patients infected with AB.Compared with non-COPD patients with lower respiratory tract infection of AB,COPD patients with AB have higher resistance rate to common clinical antibiotics.