山东省聊城市某医院老年患者下呼吸道鲍曼不动杆菌感染菌株的药敏特点及预后危险因素分析
Analysis of drug sensitivity and prognostic risk factors of Acinetobacter baumannii infection in lower respiratory tract of elderly patients in a hospital in Liaocheng City Shandong Province
刘乃政 1刘茹 1刘君华 1司磊2
作者信息
- 1. 聊城市人民医院急诊科,山东聊城 252000
- 2. 聊城市人民医院检验科,山东聊城 252000
- 折叠
摘要
目的:分析山东省聊城市某医院老年患者下呼吸道鲍曼不动杆菌感染菌株的药敏特征,探讨预后影响因素,为临床早期干预及合理用药提供理论依据.方法:回顾性分析2020年7月-2022年12月聊城某医院182例鲍曼不动杆菌下呼吸道感染老年患者的临床资料,药敏试验采用自动化仪器检测法及纸片扩散法(Kirby-Bauer,K-B)检测,根据临床和实验室标准协会(Clinical & Laboratory Standards Institute,CLSI)标准判读结果,采用WHONET5.6和SPSS 23.0统计软件进行数据分析.结果:药敏试验结果显示鲍曼不动杆菌对常用抗生素耐药率高于40％,其中对喹诺酮类、三代头孢菌素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、碳青霉烯类(美罗培南、亚胺培南)呈高度耐药,耐药率在67％～77％之间;对庆大霉素、复方磺胺甲唑的耐药率＞60％;对头孢吡肟耐药率46.7％.未见对粘菌素耐药菌株.对四环素类耐药率低,其中对替加环素耐药率0.6％,对米诺环素耐药率29.1％.多重耐药菌占比73.6％.共有54名患者死亡(29.7％),单因素分析显示,住院时间≥15天、昏迷、气管插管≥5 d、多重耐药菌感染及使用广谱抗生素有统计学意义(P＜0.05).多因素Logistic回归分析显示,气管插管≥5d、住院时间≥15天、使用广谱抗生素是患者死亡的独立危险因素(P＜0.05).结论:老年患者下呼吸道鲍曼不动杆菌感染菌株对喹诺酮类、三代头孢菌素、酶抑制剂、碳青霉烯等抗生素耐药率较高,临床需加强细菌耐药监测,合理使用抗生素,及时评估并早期干预,可改善预后,降低死亡率.
Abstract
Objective:To analyze the drug sensitivity of elderly patients with lower respiratory tract infection caused by Acinetobacter baumannii and explore the risk factors in a hospital in Liaocheng City Shandong Province,to provide theoretical basis for early clincal intervention and rational use of antimicrobial agents.Methods:During the study period from July 2020 to December 2022,clinic dates of 182 elderly patients with lower respiratory tract infections caused by Acinetobacter baumannii were retrospectively reviewed.The drug sensitivity test adopted automated instrument detection method and disk diffusion method(Kirby-Bauer,K-B),The results were interpreted according to Clinical and Laboratory Standards Institute(CLSI),using WHONET 5.6 and SPSS 23.0 statistical software to compare the drug sensitivity and prognosis factors.Results:Susceptibility test showed the resistance rate of Acinetobacter baumannii to commonly used antibiotics was more than 40％.The antibiotics including quinolones,piperacillin/tazobactam,third generation cephalosporin,cefoperazone sulbactam and carbapenems(meropenem,imipenem)showed high resistance rates between 67％～77％,followed by gentamicin and compound sulfamethoxazole with a resistance rate more than 60％.The resistance rate of cefepime was 46.7％.No strains were found resistant to colistin.The resistance rate to tetracyclines was low,with a resistance rate of 0.6％to tigecycline and 29.1％to minocycline.Detection rate of multidrug-resistant strains was 73.6％.54 patients died(29.7％).Univariate analysis showed that the statistically significant risk factors including hospitalization days≥ 1 5d,coma,tracheal intubation ≥5 d,multidrug-resistant bacterial infection,and the use of broad-spectrum antibiotics(P＜0.05).Logistic multivariate regression analysis showed that tracheal intubation ≥5 d,hospitalization days≥15 d and use of broad-spectrum antibiotics were independent risk factors for patient mortality(P＜0.05).Conclusion:Acinetobacter baumannii in elderly patients with lower respiratory tract infections showed high resistance rate to antibiotics such as quinolones,third-generation cephalosporins,enzyme inhibitors,and carbapenems,indicating the necessity to bacterial resistance monitoring and rational use of drugs.Clinicians should actively assess risk factors and give interventions,which can significantly improve the treatment effect and reduce mortality.
关键词
鲍曼不动杆菌/下呼吸道感染/老年患者/药敏特点/高危因素Key words
Acinetobacter baumannii/Lower respiratory tract infection/Elderly patient/Drug sensitivity/Risk factor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据