彭连军?王红嫚?李有霞?范绍辉?阳曼丽

【摘要】目的 探討支气管扩张症患者感染多重耐药铜绿假单胞菌（MDRP）的影响因素，为临床合理应用抗菌药物、减少多重耐药菌的产生提供科学依据。方法 回顾性分析因支气管扩张症伴感染导致住院且痰培养分离出铜绿假单胞菌（PA）的患者病历资料，依据药物敏感试验结果分为MDRP组与非MDRP组，采用t检验、χ2检验和Wilcoxon秩和检验对临床资料进行初筛，再行Logistic逐步回归分析，探讨MDRP感染的影响因素。结果 共纳入98株PA，其中MDRP组34株，非MDRP组64株，经统计分析，近1年住院次数（OR = 2.419，95%CI 1.559 ～ 3.752，P < 0.001）、ICU/呼吸重症监护病房（RICU）入住史（OR = 4.486，95%CI 1.290 ～ 15.602，P = 0.018）、咯血（OR = 4.702，95%CI 1.110 ～ 19.918，P = 0.036）是MDRP感染的影响因素。结论 近1年频繁住院、ICU/RICU入住史、咯血是MDRP感染的重要危险因素。

【关键词】支气管扩张症;铜绿假单胞菌;多重耐药菌;耐药性

Risk factors for infection of multi-drug resistant Pseudomonas aeruginosa in patients with bron-chiectasis Peng Lianjun， Wang Hongman， Li Youxia， Fan Shaohui， Yang Manli. Department of Respiratory and Critical Care Medicine， the Fifth Affiliated Hospital of Zunyi Medical University， Zhuhai 519100， China

Corresponding author， Wang Hongman， E-mail： 2496453591@ qq. com

【Abstract】Objective To explore the risk factors for the infection of multi-drug resistant Pseudomonas aeruginosa （MDRP） in patients with bronchiectasis， and to provide scientific basis for the rational application of antimicrobial agents and the reduction of multi-drug resistant bacteria （MDROs）. Method Retrospective analysis was performed on the data of patients who hospitalized with bronchiectasis associated with infection and isolated Pseudomonas aeruginosa （PA） from sputum culture. These cases were divided into MDRP group and non-MDRP group according to drug sensitivity results. Students-test， Chi-square test or Wilcoxon rank sum test was used to screen the clinical data， and then Logistic stepwise regression analysis was performed to explore the independent risk factors for MDRP infection. Results A total of 98 PA strains were collected， including 34 in the MDRP group and 64 in the non-MDRP group. Statistical analysis showed that hospitalization frequency in the recent one year （OR = 2.419，95%CI 1.559-3.752，P < 0.001）， ICU/RICU hospitalization history （OR = 4.486，95%CI 1.290-15.602，P = 0.018）， hemoptysis （OR = 4.702，95%CI 1.110-19.918，P = 0.036） were independent risk factors for MDRP infection. Conclusion Frequent hospitalization in the recent one year， ICU/RICU hospitalization history， hemoptysis are important risk factors for MDRP infection， and identification of these characteristics is beneficial to the prevention and treatment of MDRP.

【Key words】Bronchiectasis;Pseudomonas aeruginosa;Multi-drug resistant bacteria;

Drug resistance

铜绿假单胞菌（PA）是支气管扩张症中检出率最高的致病菌[1-3]。一般而言，特定病原体鉴定和抗菌药物敏感性甄别至少需要48 ～ 72 h，在此期间大部分支气管扩张症伴感染患者会接受初步的经验性抗菌药物治疗。不适当的初始抗菌药物治疗（IIAT）被认为是医院死亡的重要危险因素，也是可进行干预的重要危险因素[4]。为了使初始抗菌药物能覆盖可能的病原菌，尤其是耐药菌，临床可能增加应用广谱抗菌药物或者联合应用抗菌药物的频率，导致多重耐药菌（MDRO）的出现[5]。了解多重耐药铜绿假单胞菌（MDRP）感染的危险因素，对初始经验性抗菌药物治疗阶段识别MDRP至关重要，也有助于提高初始抗菌药物治疗的合理性。本研究对近年我科支气管扩张症伴感染患者PA药物敏感试验（药敏试验）结果进行分析，进一步研究MDRP感染的危险因素，以期为临床合理应用抗菌药物、减少MDRO的产生提供科学依据。……