| 王 琳,叶 蕊,马丽颖,杨 洁,孙依宁.急性呼吸窘迫综合征合并肺部感染患者病原菌构成、耐药性特点及死亡的影响因素分析[J].,2022,(8):1456-1460 |
| 急性呼吸窘迫综合征合并肺部感染患者病原菌构成、耐药性特点及死亡的影响因素分析 |
| Analysis of Pathogenic Bacteria Composition, Drug Resistance Characteristics and Death Influencing Factors in Patients with Acute Respiratory Distress Syndrome Complicated with Pulmonary Infection |
| 投稿时间：2021-09-02 修订日期：2021-09-27 |
| DOI：10.13241/j.cnki.pmb.2022.08.011 |
| 中文关键词: 急性呼吸窘迫综合征 肺部感染 病原菌 耐药性 影响因素 |
| 英文关键词: Acute respiratory distress syndrome Pulmonary infection Pathogenic bacteria Drug resistance Influencing factors |
| 基金项目:辽宁省自然科学基金项目（2015020548） |
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| 中文摘要: |
| 摘要 目的：探讨急性呼吸窘迫综合征（ARDS）合并肺部感染患者病原菌构成、耐药性特点及死亡的影响因素。方法：将我院从2017年1月～2020年1月收治的98例ARDS合并肺部感染患者纳入研究。所有患者均开展痰分离培养，并对分离获取的病原菌实施药物敏感试验。此外，统计入院后28 d内死亡患者例数，单因素及多因素Logistic回归分析ARDS合并肺部感染患者死亡的影响因素。结果：98例ARDS合并肺部感染患者共分离出病原菌163株，占比从高到低分别为革兰阴性菌123株占75.46%、革兰阳性菌33株占20.25%、真菌7株占4.29%。其中革兰阴性菌又以铜绿假单胞菌（50株占30.67%）、鲍氏不动杆菌（32株占19.63%）以及肺炎克雷伯菌（21株占12.88%）较为多见。铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌及溶血葡萄球菌对常见抗菌药物均有不同程度的耐药性，而肺炎克雷伯菌对头孢哌酮/舒巴坦、头孢吡肟、哌拉西林/他唑巴坦及左氧氟沙星的耐药率均为0.00%。多因素Logistic回归分析结果显示：年龄≥60岁、C反应蛋白（CRP）水平升高、降钙素原（PCT）水平升高、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分≥25分、氧合指数＜80 mmHg、入住内科重症监护室（MICU）时长≥10 d以及机械通气时间≥6 d均是ARDS合并肺部感染患者死亡的危险因素（均OR＞1，P＜0.05）。结论：ARDS合并肺部感染患者病原菌以革兰阴性菌为主，其中肺炎克雷伯菌对头孢哌酮/舒巴坦、头孢吡肟、哌拉西林/他唑巴坦及左氧氟沙星具有较好的敏感性，年龄、CRP、PCT、APACHEⅡ评分、氧合指数、入住MICU时长以及机械通气时间是此类患者死亡的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the pathogenic bacteria composition, drug resistance characteristics and death influencing factors of patients with acute respiratory distress syndrome (ARDS) complicated with pulmonary infection. Methods: From January 2017 to January 2020, 98 patients with ARDS complicated with pulmonary infection who were treated in our hospital were included in this study. Sputum isolation and culture were carried out for all patients, and drug sensitivity test was carried out for pathogenic bacteria obtained from the separation. In addition, the number of patients who died within 28 days after admission was counted, univariate and multivariate Logistic regression analysis of influencing factors of death in patients with ARDS complicated with pulmonary infection. Results: A total of 163 strains of pathogenic bacteria were detected in 98 patients with ARDS complicated with pulmonary infection, from high to low, 123 strains of Gram-negative bacteria accounted for 75.46%, 33 strains of Gram-positive bacteria accounted for 20.25%, and 7 strains of fungus accounted for 4.29%. Among them, Gram-negative bacteria were mainly Pseudomonas aeruginosa (50 strains, accounting for 30.67%), Acinetobacter baumannii (32 strains, accounting for 19.63%) and Klebsiella pneumoniae (21 strains, accounting for 12.88%). Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus and hemolytic Staphylococcus had different degrees of resistance to common antibiotics, while Klebsiella pneumoniae had 0.00% resistance to Cefoperazone/sulbactam, cefepime, piperacillin/tazobactam and levofloxacin. Multivariate Logistic regression analysis showed that age ≥60 years, elevated C-reactive protein (CRP) and procalcitonin (PCT) levels, Acute physiological Function and Chronic health status scoring system Ⅱ (APACHE Ⅱ) score ≥ 25 scores, oxygenation index < 80 mmHg, length of Medical Intensive Care Unit(MICU) stay ≥10 d and mechanical ventilation time ≥6 d were all risk factors for death in patients with ARDS complicated with pulmonary infection (all OR>1, P<0.05). Conclusion: The pathogenic bacteria of patients with ARDS complicated with pulmonary infection are mainly Gram-negative bacteria, among which, Klebsiella pneumoniae has good sensitivity to Cefoperazone /sulbactam, cefepime, piperacillin/tazobactam and levofloxacin. Age, CRP, PCT level, APACHEⅡ score, oxygenation index, length of MICU stay and mechanical ventilation time are the influencing factors for the death of these patients. |
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