摘要
目的分析2型糖尿病(T2DM)患者发生肺部感染的病原学特点及铜绿假单胞菌(PA)感染的危险因素,为T2DM患者防治PA感染提供理论依据。方法采用随机抽样法选取内蒙古自治区人民医院2017年1月—2022年12月收治的T2DM患者648例,采集痰标本进行培养,分析痰培养标本的病原学构成,记录PA肺部感染的发病情况,统计所有患者性别、年龄、合并症、免疫功能情况等临床资料,采用多因素logistic回归分析T2DM患者发生医院获得性PA肺部感染的危险因素。结果T2DM患者发生肺部感染159例、占24.54%,检出病原菌102株,检出率为64.15%(102/159),其中革兰阴性杆菌87株、占85.29%,包括肺炎克雷伯菌32例、占31.37%,PA 28例、占27.45%,鲍曼不动杆菌15例、占14.71%,大肠杆菌10例,占9.80%;革兰阳性球菌15株、占14.71%,病原菌依次是金黄色葡萄球菌11例、肺炎链球菌3例、表皮葡萄球菌1例;PA对头孢他啶、阿米卡星、庆大霉素敏感;对亚胺培南、美罗培南、左氧氟沙星、氨苄西林、氨曲南耐药;PA感染组T2DM患者的免疫功能低下、合并慢性结构性肺病、近期应用三代头孢菌素、气管插管、入住ICU比例明显高于非PA组患者,差异均有统计学意义(P<0.05)。合并慢性结构性肺病、入住ICU是院内T2DM患者发生PA肺部感染的独立危险因素。结论PA肺部感染的发生率较高,并且对抗生素耐药率较高,对于合并慢性结构性肺病、入住ICU的T2DM患者应积极给予干预,降低医院获得性PA肺部感染的患病率,提高患者治疗效果。
Objective To analyze the pathogenic characteristics of pulmonary infection in patients with type 2 diabetes mellitus(T2DM)and the risk factors of Pseudomonas aeruginosa(PA)infection,so as to provide theoretical basis for prevention and treatment of PA infection in T2DM patients.Methods A total of 648 T2DM patients admitted to Inner Mongolia Autonomous Region People's Hospital from January 2017 to December 2022 were selected by random sampling.Sputum samples were collected for culture,the pathogenic composition of sputum culture samples was analyzed,the incidence of PA pulmonary infection was recorded,and the clinical data such as gender,age,complications,and immune function of all patients were counted.The risk factors of hospital acquired PA pulmonary infection in T2DM patients were analyzed by multivariate logistic regression.Results A total of 159 patients with T2DM developed pulmonary infections,accounting for 24.54%,102 strains of pathogens were detected,with a detection rate of 64.15%(102/159).Among them,87 strains of Gram negative bacteria,accounting for 85.29%,including 32 cases of Klebsiella pneumoniae,accounting for 31.37%,28 cases of PA,accounting for 27.45%,15 cases of Acinetobacter baumannii,accounting for 14.71%,and 10 cases of Escherichia coli,accounting for 9.80%;there were 15 strains of Gram positive cocci,accounting for 14.71%.The pathogenic bacteria were 11 cases of Staphylococcus aureus,3 cases of Streptococcus pneumoniae,and 1 case of Staphylococcus epidermidis;PA was sensitive to Ceftazidime,Amikacin and Gentamicin;resistance to Imipenem,Meropenem,Levofloxacin,ampicillin and aztreonam;the proportions of T2DM patients in PA infection group with low immune function,chronic structural lung disease,recent use of third-generation Cephalosporin,Tracheal intubation,and admission to ICU were significantly higher than those in non PA group,and the differences were statistically significant(P<0.05).Concomitant chronic structural pulmonary disease and admission to the ICU were independent risk factors for the occurrence of PA pulmonary infection in T2DM patients in the hospital.Conclusion The incidence of PA pulmonary infection was high and the resistance to antibiotics was high.For T2DM patients with chronic structural lung disease and admission to ICU,active intervention should be given to reduce the incidence of hospital acquired PA pulmonary infection and improve patient treatment effect.
作者
包萨日娜
李武武
BAO Sarina;LI Wu-wu(Department of Respiratory and Critical Care Medicine,Inner Mongolia Autonomous Region People's Hospital,Hohhot Inner Mongolia Autonomous Region 010017,China)
出处
《中国城乡企业卫生》
2023年第8期15-18,共4页
Chinese Journal of Urban and Rural Enterprise Hygiene
关键词
2型糖尿病
铜绿假单胞菌肺部感染
发病趋势
危险因素
Type 2 diabetes mellitus
Pseudomonas aeruginosa pulmonary infection
Incidence trend
Risk factors
作者简介
通信作者:包萨日娜,硕士,副主任医师,研究方向:肺癌及肺部微生态,E-mail:bsrn1981@163.com。
