再生障碍性贫血并发肺部感染病原学及耐药性

Etiological characteristics of pulmonary infection in patients with aplastic anemia and drug resistance

目的分析再生障碍性贫血并发肺部感染病原学及耐药性.方法以2020年2月-2023年2月南阳医学高等专科学校第一附属医院收治的再生障碍性贫血合并肺部感染患者82例为感染组,对其进行病原菌及耐药性分析.以同期就诊的再生障碍性贫血未合并肺部感染患者76例为未感染组,比较两组血清降钙素原(PCT)、C-反应蛋白(CRP)水平,评价其对再生障碍性贫血合并肺部感染的预测价值.结果再生障碍性贫血合并肺部感染患者分离病原菌以革兰阴性菌为主,其中肺炎克雷伯菌、铜绿假单胞菌及大肠埃希菌占比最高.肺炎克雷伯菌对亚胺培南、头孢吡肟的耐药株数最少;铜绿假单胞菌对亚胺培南、阿米卡星、环丙沙星、左氧氟沙星的耐药株数均为0.感染组患者血清PCT、CRP水平均高于未感染组(P<0.05).受试者特征工作(ROC)曲线显示,PCT、CRP联合预测再生障碍性贫血合并肺部感染的曲线下面积(AUC)为0.999,灵敏度为98.78%,特异度为100.00%,联合预测效能高于各指标单独评估(P<0.05).结论革兰阴性菌是再生障碍性贫血合并肺部感染的主要病原菌,对常用抗菌药物呈现不同程度的耐药性.PCT、CRP对再生障碍性贫血合并肺部感染具有较高的预测价值,早期检测PCT、CRP可为临床提供参考.

OBJECTIVE To observe the etiological characteristics of pulmonary infection in the patients with aplastic anemia and analyze the drug resistance.METHODS A total of 82 aplastic anemia patients who were complicated with pulmonary infection and treated in the First Affiliated Hospital of Nanyang Medical College from Feb 2020 to Feb 2023 were assigned as the infection group,the distribution and drug resistance of pathogens were analyzed.Meanwhile,76 aplastic anemia patients who were not complicated with pulmonary infection were chosen as the no infection group.The levels of serum procalcitonin(PCT)and C-reactive protein(CRP)were compared between the two groups.The values of the indexes in prediction of the pulmonary infection were evaluated.RESULTS Gram-negative bacteria were dominant among the pathogens isolated from the aplastic anemia patients complicated with pulmonary infection;Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli were the predominant species.There were the fewest strains of K.pneumoniae resistant to imipenem and cefepime.There were no strains of P.aeruginosa that were resistant to imipenem,amikacin,ciprofloxacin and levofloxacin.The levels of serum PCT and CRP of the infection group were higher than those of the no infection group(P<o.05).Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of the joint detection of PCT and CRP was O0.999 in prediction of the pulmonary infection in the aplastic anemia patients,with the sensitivity 98.78%,the specificity 100.00%;the predictive efficiency of the joint detection was significantly higher than that of the single index(P<0.05),CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the aplastic anemia patients complicated with pulmonary infection and vary in the drug resistance to commonly used antibiotics.The PCT and CRP have high values in prediction of pulmonary infection in the patients with aplastic anemia,and the early detection of PCT and CRP may provide guidance for clinical treatment.