慢性阻塞性肺疾病合并呼吸机相关性肺炎病原菌分布、实验室结果分析研究

Distribution of Pathogens and Laboratory Analysis in Patients With Chronic Obstructive Pulmonary Disease Combined With Ventilator-Associated Pneumonia

目的探究慢性阻塞性肺疾病(COPD)合并呼吸机相关性肺炎(VAP)患者病原菌分布及实验室指标情况。方法选择118例COPD合并VAP患者、50例未发生感染的机械通气COPD患者及30例健康体检者纳入研究,收集药敏实验结果及实验室指标。结果118例患者共检出革兰氏阴性菌125株,以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯为主;革兰氏阳性菌31株,以金黄色葡萄球菌为主;革兰阳性菌中,鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对头孢曲松、氨曲南、环丙沙星、左氧氟沙星等药表现为较高的耐药性,三种革兰阳性菌均未检出亚胺培南、美罗培南耐药菌;革兰氏阳性菌中,金黄色葡萄球菌对环丙沙星、红霉素及青霉素等药物耐药性较高,未检出万古霉素耐药菌;COPD伴VAP组患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平显著高于COPD组及对照组,差异有统计学意义(P<0.05);血清CRP、IL-6、TNF-α水平诊断COPD伴VAP的曲线下面积为0.645、0.712、0.689。结论COPD合并VAP患者感染以革兰阳性菌感染为主,对多种药物均呈现耐药性,且伴有炎症因子水平的升高。

Objective To investigate the distribution of pathogens and laboratory indicators in patients with chronic obstructive pulmonary disease(COPD)combined with ventilator-associated pneumonia(VAP).Methods 118 patients with COPD and VAP,50 mechanically ventilated COPD patients without infection and 30 healthy physical examination patients were chosen in the study.All patients underwent bacterial culture and drug susceptibility testing and the analysis was implemented.Results There were125 gram-negative bacteria,they were mainly on Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae;There were 31 gram-positive bacteria,they were mainly on Staphylococcus aureus;Among Gram-negative bacteria,Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae showed high resistance to ceftriaxone,aztreonam,ciprofloxacin,levofloxacin,etc.No imipenem and meropenem resistant bacteria were detected in the three gram-negative bacteria.Among Gram-positive bacteria,Staphylococcus aureus has high resistance to ciprofloxacin,erythromycin and penicillin.The levels of serum C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)in the COPD with VAP group were significantly higher than those in the COPD group and the control group,and the difference was statistically significant(P<0.05).The area under the curve for the diagnosis of COPD with VAP by serum CRP,IL-6 and TNF-αlevels is 0.645,0.712,0.689.Conclusion The infection of patients with COPD and VAP is mainly on Gram-negative infection.Drug resistance to various drugs of the pathogenic bacteria in patients with infection.