社区获得性鲍曼不动杆菌性肺炎的临床特征及耐药性

Clinical characteristics and drug resistance of community-acquired Acinetobacter baumannii pneumonia

目的探讨社区获得性鲍曼不动杆菌肺炎患者的临床特征及耐药性,增加临床医生对该类肺炎的认识。方法纳入哈尔滨医科大学附属第二医院2020年1月-2021年6月呼吸内科病房标本检测为鲍曼不动杆菌,且诊断为社区获得性肺炎的患者44例,进行细菌鉴定及药敏试验,并回顾性分析其临床资料及转归。结果社区获得性鲍曼不动杆菌肺炎患者多数伴有心脑疾病及慢性肺部疾病史,临床表现主要为咳嗽、咳痰、呼吸困难、发热。肺部CT呈现多形态改变,常见双肺受累。鲍曼不动杆菌呈现出不同程度耐药性,耐药率较高的是β内酰胺类(碳青霉烯类、哌拉西林/他唑巴坦)和喹诺酮类(环丙沙星),其中对碳青霉烯类耐药率高达54.5%。结论由鲍曼不动杆菌引起的社区获得性肺炎患者以老年人为主,常伴有心脑肺部疾病,重症患者较多,但病死率较低,病原体具有不同程度耐药,需要临床医师关注。

Objective To investigate the clinical features and drug resistance of pathogens in community-acquired pneumonia patients with Acinetobacter baumannii,and to strengthen clinicians'understanding for the pneumonia.Methods From January 2020 to June 2021,a total of 44 pneumonia patients with community-acquired Acinetobacter baumannii pneumonia from the Department of Respiratory Medicine,the Second Affiliated Hospital of Harbin Medical University were enrolled,bacterial identification and drug sensitive test were performed.The clinical data and outcomes were retrospectively analyzed.Results Community-acquired Acinetobacter baumannii pneumonia patients were often accompanied by cardio-cerebral disease and/or chronic lung disease,and their clinical manifestations mainly included cough,expectoration,dyspnea,and fever.In pulmonary CT,polymorphic changes,and bilateral lung involvement were more common.Acinetobacter baumannii exhibited varying degree of drug resistance,the resistance rate of beta-lactamases(carbapenems,piperacillin/tazobactam)and quinolones(ciprofloxacin)was higher,and the rate of carbapenems resistance was as high as 54.5%.Conclusion Patients with community-acquired pneumonia cased by Acinetobacter baumannii are mainly the aged who are usually suffering from cardio-cerebral disease and pulmonary disease in such situation.Furthermore,most of those patients are critically ill,but with a low mortality rate.Drug resistance of the pathogens discovered from those patients varies in different degree.All these characteristics needs to be concerned.