医院获得性肺炎多重耐药菌感染的易感因素及耐药性分析

摘要

Objective To analyze the drug resistance and susceptibility of multidrug-resistant bacterial infection in hospital acquired pneumonia. Methods The data of 558 patients with hospital acquired pneumonia from January 2012 to December 2015 were collected and divided into multidrug-resistant and non-multidrug-resistant groups by sputum specimens. The detection and composition of multidrug-resistant bacteria were ob-serve, and the drug resistance and the susceptibility factors of multi-drug resistance in patients were analyzed. Results Among the 558 cases of pneumonia, 232 cases of multidrug-resistant strains (MDRO) were detected in sputum specimens, and the detection rate was 41.6%. Among them, Gram-positive bacteria accounted for 27.1% and Gram-negative bacteria for 72.9%. The main Gram-negative bacteria were Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli. The main Gram-positive bacteria were Staphylococcus aureus, Streptococcus pneumoniae and Enterococcus faecalis. The resistant rate of multi-drug resistant bacteria to commonly used antimicrobial agents was high. The types of antimicrobial agents used in patients, combined with chronic lung disease, cardiovascular disease, invasive operation and the use of ventilator were risk factors for multiple drug-resistant infections. Conclusions Hospital-acquired pneumonia patients with high incidence of multiple drug- resistant infections, and susceptible to commonly used antimicrobial drugre sistance, clinicians should be based on the susceptibility of patients to prevent or reduce the incidence of multiple drug-resistant strains of nosocomial infections.%目的 分析医院获得性肺炎患者多重耐药菌感染的耐药性及其易感因素.方法 选取2012年1月-2015年12月收治的558例医院获得性肺炎患者资料,通过痰标本的检验结果将其分为多重耐药组和非多重耐药组.观察多重耐药菌感染的检出及构成情况,并进行细菌耐药性分析,同时对患者发生多重耐药的易感因素进行统计学分析.结果 558例肺炎患者痰标本,检出多重耐药菌(MDRO)株232例,检出率41.6%.其中革兰阳性菌63株占27.1%,革兰阴性菌169株占72.9%.主要的革兰阴性菌种有铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌及大肠埃希菌等;主要的革兰阳性菌种有金黄色葡萄球菌,肺炎链球菌和粪肠球菌等.检测出的多重耐药菌对多种常用抗菌药物耐药率较高.患者应用抗菌药物的种类、合并慢性肺部疾病、合并心血管疾病、侵入性操作和使用呼吸机等均是多重耐药菌感染的易感因素.结论 医院获得性肺炎患者的多重耐药菌感染发生率较高,且容易对常用抗菌药物发生耐药,临床医生应根据患者的易感因素,防止或减少多重耐药菌引起医院内感染的发生,并根据药敏结果合理选择敏感的抗菌药物进行治疗.