慢性阻塞性肺疾病多重耐药菌感染的危险因素分析

摘要

Objective To analyze the risk factors of multiple drug resistant bacterial infections in patients with chronic obstructive pulmonary disease (COPD), and provide guidance for disease control and prevention. Methods Clinical data of 814 COPD patients were retrospectively analyzed from June 2011 to May 2015, including patient's age, gender, smoking history, age of onset, severity, aggravated frequency, duration of exacerbations, diabetes mellitus, complications, use frequency and use duration of glucocorticoid, use frequency of antimicrobial agents and use duration of each time, types of antimicrobial drugs used, combined with antibacterial drugs, plasma albumin concentration, blood glucose, bacteria culture detection of multi drug resistant bacteria infection. The risk factors of multi drug resistant bacteria infection were analyzed. Results A total of 857 pathogenic bacteria were isolated from 814 COPD patients with pulmonary infection. Multiple drug resistant bacteria infection were detected in 170 cases, and 175 strains (20.42%) were detected. The detection rate of multi drug resistant/PAN resistant pseudomonas aeruginosa (MDR/PDR-PA) was 55.38% (36/65). There were significant differences in patients with multi drug resistant bacteria infection between different clinical pathological characteristics. Logistic regression analysis showed that the acute exacerbation duration (days), long time use of antimicrobial drugs, and high frequency of corticosteroids and antibiotics use were independent risk factor of multi drug resistant bacteria infection in COPD patients. Conclusion Prevention and treatment of multiple drug resistant bacteria infection in COPD patients should pay attention to the combination of community and hospital, and take effective measures to prevent and control the risk factors.%目的：分析慢性阻塞性肺疾病（COPD）患者多重耐药菌感染的危险因素，为临床防控提供指导。方法回顾2011年6月—2015年5月814例COPD患者的临床资料，包括年龄、性别、吸烟史、发病年限、严重程度分级、加重频率、每次加重持续时间、糖尿病、并发症、糖皮质激素使用频率、每次使用持续时间、抗菌药物使用频率、每次平均持续时间、使用抗菌药物种数、联用抗菌药物、血浆白蛋白浓度、血糖等，监测患者多重耐药菌感染情况，并对其危险因素进行Logistic回归分析。结果814例COPD肺部感染患者共分离出病原菌857株，多重耐药菌感染者170例，检出多重耐药菌菌株175株（20.42%），其中多重耐药/泛耐药铜绿假单胞菌（MDR/PDR-PA）的检出率最高，为55.38%（36/65）。不同临床病理特征患者多重耐药菌感染情况差异均有统计学意义。Logistic回归分析结果显示，急性加重和抗菌药物持续时间长、糖皮质激素和抗菌药物使用频率高是COPD肺部多重耐药菌感染的独立危险因素。结论 COPD患者肺部多重耐药菌感染的防治应重视社区与医院结合，针对其相关危险因素采取有效防控措施。