AECOPD患者呼吸道EC耐药性及感染MREC的危险因素

EC resistance and risk factors of MREC infection in patients with AECOPD

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道的阴沟肠杆菌(EC)耐药性及感染多重耐药EC(MREC)危险因素。方法从AECOPD患者呼吸道中分离96株EC。采用全自动微生物分析仪测定EC药物敏感性,采用酶提取物三维试验法检测AmpC酶,统计总体EC、MREC、AmpC酶阳性EC在各级COPD中的分布情况,采用多因素Logistic回归分析感染MREC危险因素。结果MREC占33.3%(32株)。阿米卡星、头孢他啶、复方新诺明、左氧氟沙星、四环素、氯霉素在MREC组中的耐药率均明显高于耐药组(均P<0.05)。AmpC酶的检出率为29.2%(28株),AmpC酶阳性EC对头孢他啶、左氧氟沙星、氯霉素的耐药率均高于AmpC酶阴性EC(均P<0.05)。AmpC酶阳性EC、MREC、AmpC酶EC阳性+MREC在Ⅰ~Ⅱ级COPD的构成比明显低于Ⅲ~Ⅳ级COPD(均P<0.05)。多因素Logistic回归分析显示,"AmpC酶阳性"、"超广谱β-内酰胺酶阳性"和"COPD临床严重程度分级≥Ⅲ级"(均P<0.05)。结论感染AECOPD患者EC的耐药性严重,特别是MREC和AmpC酶阳性EC的耐药形势更是不容乐观。各种EC主要感染COPD临床严重程度分级≥Ⅲ级的患者。"AmpC酶阳性"和"超广谱β-内酰胺酶阳性"、"COPD临床严重程度分级≥Ⅲ级"是AECOPD患者感染MREC的独立危险因素。

Objective To investigate the Resistance of Enterobacter cloacae(EC)and risk factors of infection with multidrug resistant Enterobacter cloacae(MREC)in respiratory tract of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 96 EC were isolated from the respiratory tract of patients with AECOPD.The drug sensitivity of EC was determined by automatic microbial analyzer.The AmpC enzyme was detected by enzyme extract three-dimensional test.The distribution of EC,MREC and AmpC enzyme positive EC in all grade of COPD was analyzed.The risk factors of MREC infection were analyzed by multivariate logistic regression.Results MREC accounted for 33.3%(32 strains).The drug resistance rates of amikacin,ceftazidime,cmpound slfamethoxazole ganules,levofloxacin,tetracycline and chloramphenicol in MREC group were significantly higher than those in drug resistant group(P all<0.05).The detection rate of AmpC enzyme was 29.2%(28 strains).The resistance rate of AmpC enzyme positive EC to ceftazidime,levofloxacin and chloramphenicol were higher than those of AmpC enzyme negative EC(Pall<0.05).The proportion of AmpC enzyme positive EC,MREC,AmpC enzyme EC positive+MREC in COPD of grade I^II was significantly lower than those of grade III^IV(P<all 0.05).Multivariate logistic regression analysis showed that the P values of"AmpC positive","extended spectrumβ-lactamase positive"and"COPD clinical severity grade≥grade III"were all lower than 0.05.Conclusion The drug resistance of EC in patients with AECOPD is serious,especially in MREC and AmpC positive EC.All kinds of EC mainly infect patients with COPD clinical severity grade≥Ⅲ.The independent risk factors of MREC infection in AECOPD patients were"AmpC positive","ESBLs positive"and"COPD clinical severity grade≥grade III".