住院老年人细菌性肺炎多重耐药菌感染临床分析

Clinical analysis of multidrug-resistant organism infection in elderly patients with bacterial pneumonia

目的观察分析住院老年人细菌性肺炎多重耐药菌(MDRO)感染的临床特点、病原学特征和危险因素,指导合理抗MDRO治疗。方法收集2015年3月至2017年6月武汉大学中南医院老年病科和呼吸科收治的老年细菌性肺炎患者的病例资料,统计分析老年细菌性肺炎多重耐药菌组(MDRO组)与非多重耐药菌组(N-MDRO组)的一般临床特点、预后及病原学特征,并采用逻辑回归方法分析MDRO感染的危险因素。结果总计纳入患者368例,其中MDRO组267例,占比高达72.6%。两组比较分析,MDRO组较N-MDRO组年龄更高、合并各基础疾病更常见、用药史更多、平均住院时间更长、抗生素调整率更高、治疗有效率更低(P<0.05),而临床表现及炎症指标(血常规、PCT、CRP等)的差异则无统计学意义(P>0.05)。MDRO组常见的病原菌依次为鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌、屎肠球菌,其中G^-菌占比高达91.0%,非发酵菌占比达81.6%。MDRO药敏结果显示,鲍曼不动杆菌对多种药物的耐药率均高达80%以上;铜绿假单胞菌对氨基糖苷类耐药率较低;嗜麦芽假单胞菌与洋葱伯克霍尔德菌对喹诺酮类抗菌药及复方新诺明耐药率较低;大肠埃希菌与肺炎克雷伯杆菌对碳青霉烯类抗生素及β内酰胺酶抑制剂复合制剂耐药率较低;G^+菌对糖肽类抗生素及利奈唑胺无耐药。结论老年人细菌性肺炎MDRO感染发生率高,临床上应高度警惕,准确识别多重耐药菌感染需多方面综合评估。MDRO感染以G^-菌为主,非发酵菌占有重要地位,其耐药情况各异,应行针对性治疗。加强住院老人MDRO感染的危险因素的控制,可减少多重耐药菌感染。

Objective To analyze the clinical characteristics,pathogenic characteristics and risk factors of bacterial pneumonia with multidrug-resistant organism(MDRO)infection in the elderly in order to guide the rational anti-MDRO treatment.Methods From March 2015 to June 2017,the data of elderly patients with bacterial pneumonia admitted to the department of geriatrics and respiratory of Zhongnan Hospital of Wuhan University were collected.The general clinical characteristics,prognosis and pathogenic characteristics of the MDRO group and the N-MDRO group were statistically analyzed.The risk factors of MDRO infection were analyzed by logistic regression method.Results A total of 368 patients were included,including 267 in MDRO group,accounting for 72.6%.Compared with N-MDRO group,MDRO group was older,more common with basic diseases,more medication history,longer average hospital stay,higher antibiotic adjustment rate and lower treatment efficiency(P<0.05),but there was no significant difference in clinical manifestations and inflammatory indexes(blood routine test,PCT,CRP,etc.).The common pathogens in MDRO group were Acinetobacter baumannii,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Burkholderia cepacia,Staphylococcus aureus,Escherichia coli,Klebsiella pneumoniae,and Enterococcus faecium,in which G^-bacteria accounted for 91.0%and non fermentative bacteria accounted for 81.6%.The results of MDROs showed that Acinetobacter baumannii was more than 80%resistant to a variety of drugs;Pseudomonas aeruginosa was less resistant to aminoglycosides;Pseudomonas maltophilia and Burkholderia cepacia were less resistant to quinolones and compound neoformamine;Escherichia coli and Klebsiella pneumoniae were less resistant to carbapenems andβ-lactamase inhibitors.G^+bacteria had no resistance to glycopeptide antibiotics and linezolid.Conclusion The incidence of MDRO infection of bacterial pneumonia in the elderly is high,so we should pay more attention to it in clinical practice.It needs comprehensive evaluation in many aspects to recognize MDRO infection accurately.MDRO infection is mainly caused by G^-bacteria,and non fermenting bacteria play an important role in MDRO infection.Strengthening the control of risk factors of MDRO infection in the elderly can reduce the infection of multidrug-resistant bacteria.