慢性阻塞性肺疾病合并呼吸衰竭患者院内感染病原菌的耐药特征与危险因素分析

Analysis of resistance characteristics and risk factors of nosocomial pathogens in patients with chronic obstructive pulmonary disease complicated by respiratory failure

摘要:

目的 探讨慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者院内感染病原菌的耐药特征及其相关危险因素，优化临床医生对该群体的感染管理与治疗策略。方法 回顾性选取2021年7月—2024年7月北京中医医院怀柔医院198例COPD合并呼吸衰竭患者的临床资料。根据患者是否并发呼吸机相关性肺炎分为肺炎组（86例）与非肺炎组（112例）。比较两组患者相关实验室指标水平。统计并分析肺炎患者病原菌分布情况及耐药性情况。采用多因素一般Logistic回归模型分析COPD合并呼吸衰竭患者发生院内感染的影响因素。结果 肺炎组血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、酸性α-糖蛋白（AAG）、血清淀粉样蛋白A（SAA）、降钙素原（PCT）、Toll样受体4（TLR4）、核因子κ（NF-κB）水平均高于非肺炎组（P <0.05）。肺炎组共检出病原菌237株，以革兰阴性菌为主（59.49%），其中铜绿假单胞菌占比最高（35.46%）；革兰阳性菌占22.36%，以金黄色葡萄球菌为主（52.83%）。主要革兰阴性菌（铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌）对头孢噻肟、头孢吡肟等头孢类抗菌药物耐药率较高，对美罗培南、亚胺培南耐药率较低；主要革兰阳性菌（金黄色葡萄球菌、溶血葡萄球菌）对红霉素、氨苄西林耐药率较高，对万古霉素、利奈唑胺耐药率较低。多因素一般Logistic回归分析结果显示，IL-6水平高［O^R =3.436（95% CI：1.097，10.762）］、TNF-α水平高［O^R =4.398（95% CI：1.023，18.908）］、AAG水平高［O^R =3.316（95% CI：1.068，10.296）］、SAA水平高［O^R =2.984（95% CI：1.135，7.845）］、PCT水平高［O^R =2.801（95% CI：1.047，7.493）］、TLR4水平高［O^R =2.801（95% CI：1.047，7.493）］、NF-κB水平高［O^R =4.066（95% CI：1.184，13.963）］均为COPD合并呼吸衰竭患者发生院内感染的危险因素（P <0.05）。结论 COPD合并呼吸衰竭患者院内感染的病原菌以革兰阴性菌为主，且显示出显著的耐药性。早期准确的病原菌识别及耐药性分析对于制订有效的抗感染治疗策略至关重要。

Abstract:

Objective To clarify the drug resistance characteristics of nosocomial pathogenic bacteria and their related risk factors in patients with chronic obstructive pulmonary disease (COPD) complicated by respiratory failure, so as to optimize clinical infection management and treatment strategies for this population.Methods A total of 198 patients with COPD complicated by respiratory failure admitted to our hospital from July 2021 to July 2024 were retrospectively enrolled. They were divided into the pneumonia group (86 cases) and non-pneumonia group (112 cases) based on the occurrence of ventilator-associated pneumonia. Laboratory indicators were compared between the two groups. The distribution and drug resistance of pathogenic bacteria in the pneumonia group were statistically analyzed. multivariate logistic regression model analysis of influencing factors for hospital-acquired infections in COPD patients with respiratory failure.Results Serum IL-6, TNF-α, AAG, SAA, PCT, TLR4, and NF-κB levels in the pneumonia group were significantly higher than those in the non-pneumonia group (P < 0.05). A total of 237 pathogenic strains were detected in the pneumonia group, mostly Gram-negative bacteria (59.49%), with Pseudomonas aeruginosa accounting for the highest proportion (35.46%); Gram-positive bacteria accounted for 22.36%, mainly Staphylococcus aureus (52.83%). Main Gram-negative bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae) had relatively high resistance to cephalosporins (e.g., cefotaxime, cefepime) but low resistance to meropenem and imipenem. Main Gram-positive bacteria (Staphylococcus aureus, Staphylococcus haemolyticus) showed high resistance to erythromycin and ampicillin, but low resistance to vancomycin and linezolid. Multivariate Logistic regression analysis indicated that high IL-6[O^R = 3.436 (95% CI：1.097, 10.762)], TNF-α[O^R = 4.398 (95% CI：1.023, 18.908)], AAG[O^R = 3.316 (95% CI：1.068, 10.296)], SAA[O^R = 2.984 (95% CI：1.135, 7.845)], PCT[O^R = 2.801 (95% CI：1.047, 7.493)], TLR4[O^R = 2.801 (95% CI：1.047, 7.493)], and NF-κB[O^R = 4.066 (95% CI：1.184, 13.963)] levels were all independent risk factors for nosocomial infection in COPD patients with respiratory failure (P < 0.05).Conclusion Gram-negative bacteria are the main nosocomial pathogens in patients with COPD complicated by respiratory failure, with significant drug resistance. Early and accurate identification of pathogens and analysis of their drug resistance are crucial for formulating effective anti-infection treatment strategies.