摘要
目的探讨慢性阻塞性肺疾病(COPD)住院患者呼吸道感染铜绿假单胞菌(PA)的耐药特点及临床特征。方法回顾性分析2018年3月-2019年10月汉川市人民医院住院的78例COPD呼吸道感染PA患者为PA组,并以同期非呼吸道感染COPD患者48例为对照组。分析PA的耐药特点及变化趋势,记录患者各项临床资料,分析导致PA感染发生的影响因素及血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平对COPD呼吸道感染PA的诊断价值。结果从78例COPD呼吸道PA感染患者的痰液中共分离得到得到78株PA。在选取的13种抗菌药物中,PA对头孢噻肟的耐药率最高为44.87%;多因素Logistic回归分析表明,有低蛋白血症、COPD分级Ⅲ-Ⅳ、6 min步行距离(6MWD)<250 m、COPD评估测试(CAT)评分>20分、近1年内急性加重次数>5以及抗菌药物使用时间>14 d均为影响COPD住院患者呼吸道PA感染的独立危险因素;PCT、CRP、IL-6联合诊断呼吸道PA感染的曲线下面积(AUC)高于三者单独诊断AUC值(P<0.05)。结论 COPD住院患者呼吸道感染PA耐药现象严重,临床可重点关注有低蛋白血症、COPD分级Ⅲ-Ⅳ、6MWD<250 m、CAT评分>20分、近1年内急性加重次数>5、抗菌药物使用时间>14 d患者。
OBJECTIVE To explore the drug resistance of Pseudomonas aeruginosa strains isolated from hospitalized chronic obstructive pulmonary disease(COPD) patients with respiratory tract infection and analyze the clinical characteristics. METHODS A total of 78 COPD patients with respiratory tract PA infection who were hospitalized in Hanchuan People’s Hospital from Mar 2018 to Oct 2019 were assigned as the PA group, meanwhile, 48 COPD patients with non-respiratory tract infection were set as the control group. The changing trends of drug resistance of the P.aeruginosa strains were analyzed, the clinical data of the patients were recorded, the influencing factors for the P.aeruginosa infection were analyzed, and the values of serum procalcitonin(PCT), C-reactive protein(CRP) and interleukin-6(IL-6) in diagnosis of respiratory tract P.aeruginosa infection were observed. RESULTS Totally 78 strains of P.aeruginosa were isolated from sputum specimens of 78 COPD patients with respiratory tract P.aeruginosa infection. Among the 13 types of antibiotics, the drug resistance rate of P.aeruginosa to cefotaxime was the highest(44.87%). Multivariate logistic regression analysis showed that hypoproteinemia, grade III-IV of COPD, 6 min walking distance(6 MWD) shorter than 250 m, COPD assessment test(CAT) score more than 20 points, number of times of acute exacerbation in the past year more than 5 and time of use of antibiotics more than 14 days were the independent risk factors for the respiratory tract P.aeruginosa infection in the hospitalized COPD patients. The area under curve(AUC) of the joint detection of PCT, CRP and IL-6 was significantly higher than that of the single detection of the indexes in diagnosis of respiratory tract P.aeruginosa infection(P<0.05). CONCLUSION The P.aeruginosa strains isolated from the hospitalized COPD patients with respiratory tract infection are highly drug-resistant. It is necessary for the hospital to focus on the patients with hypoproteinemia, grade Ⅲ-Ⅳ of COPD, 6 MWD shorter than 250 m, CAT
作者
何利波
金艳
周芬
余明红
何丽萍
HE Li-bo;JIN Yan;ZHOU Fen;YU Ming-hong;HE Li-ping(Hanchuan People’s Hospital,Hanchuan,Hubei 431600,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第21期3259-3263,共5页
Chinese Journal of Nosocomiology
基金
湖北省科研基金资助项目(201921411)。
关键词
慢性阻塞性肺疾病
铜绿假单胞菌
耐药
影响因素
Chronic obstructive pulmonary disease
Pseudomonas aeruginosa
Drug resistance
Influencing factor
