支气管扩张症急性加重期多重耐药菌感染的影响因素分析

Analysis of influencing factors of multi-drug resistant bacteria infection in patients with acute exacerbation of bronchiectasis

目的探讨支气管扩张症急性加重期患者多重耐药(multi-drug resistance,MDR)菌感染的影响因素。方法选取2006年1月至2021年12月北京市顺义区医院呼吸内科住院的支气管扩张急性加重期且痰细菌培养阳性的患者244例,收集患者的一般资料、MDR菌检出情况和细菌耐药情况,采用多因素logistic回归方程分析MDR菌感染的影响因素。结果244例患者中男125例,女119例;年龄38~86岁,平均(62.3±9.2)岁。244例患者共培养细菌272株,前3位细菌为铜绿假单胞菌(54.4%)、鲍曼不动杆菌(12.9%)、肺炎克雷白菌(5.9%)。多因素logistic回归分析显示,3个月内广谱抗菌药物使用(OR=3.308,95%CI:1.753~6.244,P=0.000)、住重症监护室(OR=4.633,95%CI:1.780~12.054,P=0.002)、血清白蛋白<30 g/L(OR=3.388,95%CI:1.525~7.525,P=0.003)是MDR菌感染的独立危险因素。结论支气管扩张症急性加重期患者病原菌以革兰阴性杆菌为主,其中铜绿假单胞菌分离率最高;为减少MDR菌的产生及扩散,应有针对性地选择敏感抗菌药物,并避免抗生素长期应用。

Objective To explore the influencing factors of multi-drug resistant bacteria infection in patients with acute exacerbation of bronchiectasis.Methods A total of 244 patients with acute exacerbation of bronchiectasis who were hospitalized in the Department of Respiratory Medicine of Shunyi District Hospital in Beijing from January 2006 to December 2021 and had positive sputum bacterial culture were selected.The general data of the patients,the detection of multi-drug resistant bacteria and bacterial resistance were collected and compared.Multivariate logistic regression equation was used to analyze the influencing factors of multi-drug resistance.Results Among 244 patients,125 were male and 119 were female.The mean age was(62.3±9.2)years(38~86 years old).A total of 272 strains of bacteria were cultured among the 244 patients,and the top three bacteria were Pseudomonas Aeruginosa(54.4%),Acinetobacter Baumanni(12.9%),Klebsiella Pneumoniae(5.9%).Multivariate logistic regression analysis showed that broad-spectrum antibiotics use(OR=3.308,95%CI:1.753-6.244,P=0.000),intensive care unit admission(OR=4.633,95%CI:1.780-12.054,P=0.002)and serum albumin<30 g/L(OR=3.388,95%CI:1.525-7.525,P=0.003)were independent risk factors for multi-drug resistant bacteria infection.Conclusions Gram-negative bacilli are the main pathogens in patients with acute exacerbation of bronchiectasis,and Pseudomonas aeruginosa has the highest isolation rate.Sensitive antibiotics should be selected and longterm use of antibiotics should be avoided to reduce the generation and spread of multi-drug resistant bacteria.