医院下呼吸道感染多重耐药菌耐药现状及影像学特点分析

Analysis of the current status and imaging characteristics of multi-drug resistant bacteria in hospital lower respiratory tract infections

目的分析医院下呼吸道感染多重耐药菌检出情况及胸部影像学特点。方法选择医院746例下呼吸道感染且2次以上痰培养细菌呈阳性并为同一菌株的住院患者送检的痰标本作为研究对象,运用WHONET 5.6分析多重耐药菌的检出率、耐药性及胸部影像学表现。结果共检出下呼吸道感染多重耐药菌株746株,其中耐甲氧西林金黄色葡萄球菌56株(7.51%),革兰阴性杆菌690株(92.49%)。在革兰阴性多重耐药菌株中,产超广谱β-内酰胺酶大肠埃希菌117株(15.68%);产超广谱β-内酰胺酶肺炎克雷伯杆菌190株(25.47%),耐碳青霉烯类大肠埃希菌3株(0.40%),耐碳青霉烯类肺炎克雷伯杆菌21株(2.82%),多重耐药鲍曼不动杆菌198株(26.54%),多重耐药铜绿假单胞菌161株(21.58%),未检出耐万古霉素肠球菌。56株耐甲氧西林金黄色葡萄球菌对万古霉素、利奈唑胺、替考拉宁、氯霉素的耐药率均为0,对克林霉素、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率在30%以上,对复方新诺明、阿米卡星、莫西沙星耐药率波动在5.36%~26.79%;革兰阴性多重耐药菌株中,产超广谱β-内酰胺酶大肠埃希菌对亚胺培南和美罗培南敏感,对左氧氟沙星、哌拉西林及环丙沙星耐药率高;产超广谱β-内酰胺酶肺炎克雷伯杆菌对亚胺培南和美罗培南敏感,对哌拉西林和复方新诺明耐药率高;多重耐药铜绿假单胞菌和鲍曼不动杆菌对12种抗菌药均表现为高耐药率,二者均对复方新诺明耐药性最低,多重耐药鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率也较低。多重耐药菌肺部感染多累及多个肺段(87.44%),常合并多种影像学表现(73.91%),说明细菌有多种侵袭力,其中16.91%有破坏性的影像学表现,以金黄色葡萄球菌、肺炎克雷伯杆菌、铜绿假单胞菌为主。结论医院下呼吸道耐药菌感染现状严峻,应严格控制感染因素,减少耐药菌的产生。

Objective To analyze the detection of multi-drug resistant bacteria in hospital lower respiratory tract infection and the characteristics of chest imaging. Methods The sputum specimens of 746 hospitalized patients with lower respiratory tract infection and more than two sputum cultures positive of the same strain were selected as the research subjects. WHONET 5.6 was used to analyze the detection rate, drug resistance and resistance of multi-drug resistant bacteria, and chest imaging findings. Results A total of 746 multidrug-resistant strains of lower respiratory tract infection were detected, including 56 strains(7.51%) of methicillin-resistant Staphylococcus aureus and 690 strains(92.49%) of gram-negative bacilli. Among gram-negative multi-drug resistant strains, 117 strains(15.68%) of extended-spectrum β-lactamaseproducing Escherichia coli;190 strains(25.47%) of extended-spectrum β-lactamase-producing Klebsiella pneumoniae, 3 strains(0.40%) of carbapenem-resistant Escherichia coli, 21 strains(2.82%) of carbapenemresistant Klebsiella pneumoniae, and 198 strains(26.54%) of multi-drug-resistant Acinetobacter baumannii, 161 strains(21.58%) of multi-drug resistant Pseudomonas aeruginosa, no vancomycin-resistant enterococci were detected. The resistance rates of 56 strains of methicillin-resistant Staphylococcus aureus to vancomycin, linezolid, teicoplanin, and chloramphenicol were all 0, which was above 30% to clindamycin, cefoperazone/sulbactam, piperacillin/tazobactam, and fluctuated between 5.36% and 26.79% to compound sulfamethoxazole, amikacin, and moxifloxacin. Among the gram-negative multi-drug resistant strains, the extended-spectrum β-lactamase-producing Escherichia coli was sensitive to imipenem and meropenem, and had high resistance rates to levofloxacin, piperacillin and ciprofloxacin;the extended-spectrum β-lactamase-producing Klebsiella pneumoniae was sensitive to imipenem and meropenem, and had a high resistance rate to piperacillin and compound sulfamethoxazole;multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii showed high resistance rates to 12 kinds of antibiotics, and both of them had the lowest resistance to compound sulfamethoxazole. The resistance rate of multidrug resistant Acinetobacter baumannii to cefoperazone/sulbactam was also low. Pulmonary infections of multi-drug-resistant bacteria mostly involved multiple lung segments(87.44%), often combined with multiple imaging findings(73.91%), indicating that the bacteria had a variety of invasiveness, of which 16.91% had destructive imaging findings, mainly Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusion The current situation of drug-resistant bacteria infection in hospitals of lower respiratory tract is serious.The risk factors of infection should be controlled to reduce the production of resistant bacteria.