慢性阻塞性肺疾病住院患者多重耐药菌主动筛查定植与感染分析

Active screening and colonization of multidrug-resistant bacteria and analysis of infection in hospitalized patients with chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)住院患者多重耐药菌主动筛查定植与感染情况。方法选取2017年9月-2018年9月在本院住院的COPD患者120例为研究对象,收集患者鼻拭子、咽拭子、肛拭子、大便、血液、痰等标本,采用显色培养基筛查非定植30例,定植60例、耐药感染30例,对多重耐药菌的定植与感染的状态情况进行分析,采用Logistic回归分析多重耐药感染的危险因素。结果感染组患者>65岁患者占66.7%,住院天数>10 d占60.0%,伴有糖尿病、肾功能不全、恶性肿瘤、意识障碍的患者占53.3%,明显高于非定植、定植组(P<0.05)。ESBLs大肠埃希菌感染率为61.1%,耐甲氧西林葡萄球菌感染率为71.4%,ESBLs肺炎克雷伯杆菌感染率为64.3%,耐万古霉素肠球菌感染率为66.7%。气管插管、糖尿病、意识障碍、肾功能不全是患者耐药感染的独立危险因素(P<0.05)。结论COPD患者多重耐药定植和感染风险较高,早期识别多重耐药菌定植与感染具有重要的临床意义。

Objective To investigate the active screening,colonization and infection of multidrug-resistant bacteria in hospitalized patients with chronic obstructive pulmonary disease(COPD).Methods A total of 120 COPD patients who were hospitalized in our hospital from September 2017 to September 2018 were selected.Nasal swab,pharyngeal swab,anal swab,stool,blood,sputum and other specimens were collected from all the patients.30 non-colonized cases were screened by color medium,60 cases were colonized,and 30 cases were resistant to multi-drug-resistant bacteria.The status of colonization and infection was analyzed,and the risk factors of multi-drug resistance infection were analyzed by Logistic regression.Results In the infection group,66.7%were over 65 years old,60.0%were hospitalized for more than 10 days,53.3%were accompanied by diabetes mellitus,renal insufficiency,malignant tumors and disturbance of consciousness,which were significantly higher than those in the non-colonized and colonized groups(P<0.05).The infection rate of ESBLs was 61.1%in 36 cases of Escherichia coli,71.4%in 28 cases of methicillin-resistant Staphylococcus and 71.4%in ESBLs pneumonia.The infection rate of Klebsiella was 64.3%in 14 cases and 66.7%in 12 cases of vancomycin-resistant Enterococcus.Tracheal intubation,diabetes mellitus,disturbance of consciousness and renal insufficiency were independent risk factors for drug-resistant infection.Conclusion The risk of multi-drug resistance colonization and infection is high in COPD patients.Tracheal intubation,diabetes mellitus,disturbance of consciousness and renal insufficiency are risk factors for drug resistance infection.