肺结核呼吸衰竭患者发生肺部感染的影响因素及病原菌分布和耐药性分析

Influencing factors of pulmonary infection in patients with pulmonary tuberculosis and respiratory failure and distribution and drug resistance of pathogenic bacteria

目的:分析肺结核呼吸衰竭患者发生肺部感染的影响因素及病原菌分布和耐药性。方法:选取2019年2月至2020年3月河南省人民医院收治的59例肺结核呼吸衰竭患者进行前瞻性研究,统计肺部感染发生率,将发生肺部感染的患者纳入感染组,未发生肺部感染患者纳入未感染组,比较两组一般资料,分析肺结核呼吸衰竭患者发生肺部感染的影响因素,以及患者痰标本病原菌分布和耐药性。结果:59例肺结核呼吸衰竭患者中,25例发生肺部感染,发生率为42.37%(25/59);两组性别、血红蛋白水平比较,差异均无统计学意义(P>0.05);感染组年龄≥60岁、器官损害数目≥3个、急性生理与慢性健康系统(APACHEⅡ)评分≥17分、白蛋白(ALB)<35 g/L、机械通气时间>3 d占比均高于未感染组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,年龄≥60岁、器官损害数目≥3个、APACHEⅡ评分≥17分、ALB<35 g/L、机械通气时间>3 d均为肺结核呼吸衰竭患者发生肺部感染的危险因素(OR>1,P<0.05);25份痰标本共分离40株菌株,革兰阴性菌29株,占72.50%,革兰阳性菌6株,占15.00%,真菌5株,占12.50%,主要病原菌为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌;鲍曼不动杆菌对四环素、头孢哌酮、头孢呋辛、头孢唑啉、氨苄西林耐药率均≥80%,肺炎克雷伯菌、铜绿假单胞菌对头孢呋辛、头孢唑啉、氨苄西林耐药率均>83%。结论:年龄≥60岁、器官损害数目≥3个、APACHEⅡ评分≥17分、ALB<35 g/L、机械通气时间>3 d均为肺结核呼吸衰竭患者发生肺部感染的危险因素,且诱发肺部感染的病原菌分布和耐药性呈多样性和多重耐药性。

Objective:To analyze influencing factors of pulmonary infection in patients with pulmonary tuberculosis and respiratory failure and the distribution and drug resistance of pathogenic bacteria in sputum specimens.Methods:A prospective study was conducted on 59 patients with pulmonary tuberculosis and respiratory failure admitted to Henan Provincial People’s Hospital from February 2019 to March 2020.The incidence of pulmonary infection was statistically analyzed.The patients with pulmonary infection were included in infection group,while those without infection were included in non-infection group.The general data of the two groups were compared.The influencing factors of pulmonary infection in the patients with pulmonary tuberculosis and respiratory failure as well as the distribution and drug resistance of pathogenic bacteria in the sputum specimens were analyzed.Results:Among the 59 patients with pulmonary tuberculosis and respiratory failure,25 had pulmonary infection with an incidence of 42.37%(25/59).There were no significant differences in gender and hemoglobin ratio between the two groups(P>0.05).The proportions of age≥60 years old,the number of organ damage≥3,the acute physiology and chronic health system(APACHE II)score≥17,albumin(ALB)<35 g/L,and mechanical ventilation time>3 d in the infection group were higher than those in the non-infection group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age≥60 years old,number of organ damage≥3,APACHE II score≥17,ALB<35 g/L and mechanical ventilation time>3 d were all risk factors for pulmonary infection in the patients with pulmonary tuberculosis and respiratory failure(OR>1,P<0.05).A total of 40 strains were isolated from the 25 sputum specimens,including 29 strains of gram-negative bacteria(72.50%),6 strains of gram-positive bacteria(15.00%)and 5 strains of fungi(12.50%).The main pathogens were Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae.The resistance rates of Acinetobacter baumannii to Tetracycline,Cefoperazone,Cefuroxime,Cefazolin and Ampicillin were≥80%.The resistance rates of Klebsiella pneumoniae and Pseudomonas aeruginosa to Cefuroxime,Cefazolin and Ampicillin were>83%.Conclusions:Age≥60 years old,number of organ damage≥3,APACHE II score≥17,ALB<35 g/L,and mechanical ventilation time>3 d are the risk factors for pulmonary infection in the patients with pulmonary tuberculosis respiratory failure.The distribution pathogenic bacteria that induce pulmonary infection are diverse and they are multi drug resistant.