多重耐药革兰阴性杆菌重症肺炎的临床观察

Clinical observation of severe pneumonia caused by multidrug-resistant Gram-negative bacilli

目的探究多重耐药革兰阴性杆菌重症肺炎的危险因素及预后情况。方法选取2015年1月至2019年12月本院收治的46例重症肺炎且经细胞培养显示为革兰阴性杆菌感染患者为研究对象,根据是否多重耐药分为多重耐药组(n=26)与非多重耐药组(n=20)。比较两组理化指标、急慢性APACHE-Ⅱ评分及预后情况。结果46例患者共分离革兰阴性杆菌122株;多重耐药试验发现革兰阴性菌对庆大霉素耐药性高,鲍曼不动杆菌对抗生素耐药性高,大肠埃希杆菌对环丙沙星具有较高耐药性;与非多重耐药组相比,多重耐药组APACHE-Ⅱ评分较高、住院时间长、死亡率高、血清白蛋白水平低,差异均有统计学意义(P<0.05)。结论多重耐药革兰阴性杆菌预后差、死亡率高,应加强药敏检测,合理应用抗生素,增强患者预后,值得临床推广应用。

Objective To explore the risk factors and prognosis of severe pneumonia caused by multidrug-resistant Gram-negative bacilli.Methods 46 patients with severe pneumonia in our hospital from January 2015 to December 2019 who were infected with Gram-negative bacilli after cell culture were selected as the research subjects.According to whether they were multidrug-resistant,they were divided into multidrug-resistant group(n=26)and non-multidrug-resistant group(n=20).The physical and chemical indicators,acute and chronic APACHE-Ⅱscores and prognosis were compared between two groups.Results 122 strains of Gram-negative bacilli were isolated from 46 patients.The multiple drug resistance test showed that Gram-negative bacilli had a high resistance rate to gentamicin,Acinetobacter baumannii had high resistance to antibiotics,and Escherichia coli had high resistance to ciprofloxacin.Compared with the non multiple drug resistance group,the multiple drug resistance group had higher APACHE-Ⅱscore,long hospital stay,high mortality rate,and serum albumin,the difference was statistically significant(P<0.05).Conclusion Multidrug-resistant Gram-negative bacilli have a poor prognosis and high mortality.Drug sensitivity testing should be strengthened,antibiotics should be used rationally,and the prognosis of patients should be enhanced.It is worthy of clinical application.