成年人下呼吸道感染者痰液病原菌分布及多重耐药菌感染风险因素分析

Distribution of pathogenic bacteria from sputum samples and risk factors of multiple drug resistant organism infection from adults with lower respiratory tract infection

目的探讨新型冠状病毒疾病(COVID-19)后疫情时期成人下呼吸道感染者痰标本中的病原菌分布、耐药性以及多重耐药菌(MDRO)感染的影响因素。方法回顾性分析2021年1月至2022年12月鹰潭184医院收治的316例成年人下呼吸道感染患者的临床资料,对其痰标本培养首次检出的107株病原菌进行菌种鉴定及药敏分析,依据药敏结果分为MDRO组(n=62)和非MDRO组(n=45),比较MDRO组和非MDRO组患者的临床资料,应用多因素Logistic回归分析探讨多重耐药菌感染的影响因素。结果107株病原菌中,检出比例位居前3的分别为肺炎克雷伯菌(29.91%)、大肠埃希菌(16.82%)、铜绿假单胞菌(14.95%),其中MDRO占比57.94%,非MDRO占比42.06%。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌对头孢唑林的耐药率分别为90.63%、57.89%、88.89%和81.25%,对头孢噻肟的耐药率分别为59.38%、52.63%、72.22%和68.75%,对氨曲南的耐药率分别为46.88%、42.11%、44.44%和87.50%。多重耐药菌组患者年龄≥60岁、住院天数≥7 d、接受有创治疗、白球比值<1、血红蛋白(Hb)水平<100 g/L以及C反应蛋白(CRP)≥30 mg/L的患者比例明显高于非多重耐药组,差异均有统计学意义(P<0.05)。患者年龄≥60岁、住院天数≥7 d是成年人下呼吸道感染MDRO的危险因素(P<0.05),而Hb水平≥100 g/L是保护性因素(P<0.05)。结论COVID-19后疫情时期,成人下呼吸道感染患者病原菌分布发生变化,对第一、二代头孢菌素普遍耐药严重,MDRO占比高。患者年龄、住院天数和Hb水平是后疫情时期成人下呼吸道MDRO感染的独立风险因素,合理干预这些风险因素,有利于临床控制MDRO传播。

Objective To investigate the distribution of pathogenic bacteria from sputum samples,drug resistance,and the influencing factors of multiple drug resistant organism(MDRO)infection in adults with lower respiratory tract infection in post coronavirus disease 2019(COVID-19)period.Methods The clinical data of 316 adult patients with lower respiratory tract infection admitted to the 184th Hospital of Yingtan from January 2021 to December 2022 were retrospectively analyzed.From initial sputum samples of these patients,107 strains of pathogenic bacteria were identified and tested for drug susceptibility,which were divided into MDRO group(n=62)and non-MDRO group(n=45)according to results of drug susceptibility.The clinical data were compared between patients in MDRO and non-MDRO group,and the influence factors of MDRO infection were explored by multivariate logistic regression analysis.Results Among the 107 strains of pathogenic bacteria,the top 3 bacteria in distribution ratio were Klebsiella pneumoniae(29.91%),Escherichia coli(16.82%),and Pseudomonas aeruginosa(14.95%),consisting of 57.94%MDRO and 42.06%non-MDRO.The drug-resistance rates of Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumannii were 90.63%,57.89%,88.89%,and 81.25%to cefazolin,59.38%,52.63%,72.22%,and 68.75%to cefotaxime,and 46.88%,42.11%,44.44%,and 87.50%to amtranam,respectively.The proportion of patients with age≥60 years,hospital stay≥7 days,invasive treatment,the ratio of albumin to globulin<1,Hb level<100 g/L,and CRP≥30 mg/L in MDRO group were all significantly higher than that in non-MDRO group(P<0.05).Age≥60 years and hospital stay≥7 days were the risk factors and Hb≥100 g/L was the protective factor for adult lower respiratory tract infection by MDRO(P<0.05).Conclusion In post COVID-19 period,the pathogens causing adult lower respiratory tract infection have changed in distribution and are generally resistant to the first and second generation cephalosporins,in which MDRO has a higher proportion.Patient's age,hospital stay,and Hb level are independent risk factors for lower respiratory tract infection by MDRO in adults.Therefore,reasonable clinical intervention of above risk factors is beneficial to control the spread of MDRO.