支气管扩张患者感染铜绿假单胞菌的 相关危险因素及其耐药性分析

Risk Factors and Drug Resistance Analysis of Pseudomonas Aeruginosa Infection in Patients with Bronchiectasis

摘要:

〔摘 要〕 目的：分析支气管扩张患者感染铜绿假单胞菌（PA）的相关危险因素及其耐药性。 方法：选取 2020 年 1 月至 2023 年 6 月广东医科大学附属东莞第一医院收治的 536 例支气管扩张患者作为研究对象，所有患者均进行痰液或肺泡灌洗 液培养，根据培养结果将患者分为 PA 感染组与未感染组，比较两组患者的相关资料，分析支气管扩张患者感染 PA 的相关 危险因素。之后对 PA 的耐药性进行分析。 结果：536 例支气管扩张患者中，有 86 例 PA 阳性，占比为 16.04 %（86/536）。 logistic 回归分析结果显示：病程≥ 12 个月、影像学囊柱状型表现、急性加重次数≥ 2 次、1 年内入院次数≥ 2 次是支气管 扩张患者感染 PA 的独立危险因素（OR ≥ 1，P ＜ 0.05）。PA 对头孢噻肟耐药率（100.00 %）及四环素耐药率（97.67 %） 极高、莫西沙星耐药率（40.70 %）次之，对哌拉西林 / 他唑巴坦（3.49 %）、头孢哌酮 / 舒巴坦（8.14 %）耐药性较低。 结论：支气管扩张患者 PA 感染率较高，病程≥ 12 个月、影像学囊柱状型表现、急性加重次数≥ 2 次、1 年内入院次数≥ 2 次 是其独立危险因素，且 PA 对头孢噻肟、四环素天然耐药，临床应制定针对性防治措施，以改善患者预后。

关键词:支气管扩张;铜绿假单胞菌;危险因素;耐药性

Abstract:

〔Abstract〕 Objective To analyze the risk factors and drug resistance of pseudomonas aeruginosa (PA) infection in patients with bronchiectasis. Methods A total of 536 patients with bronchiectasis admitted to the First Dongguan Affiliated Hospital of Guangdong Medical University from January 2020 to June 2023 were selected as the study subjects. All patients underwent sputum or alveolar lavage fluid culture. Based on the culture results, the patients were divided into PA infected and non infected groups. The relevant data of the two groups were compared to analyze the risk factors of PA infection group in bronchiectasis patient. Afterwards, the drug resistance of PA was analyzed. Results Among the 536 patients with bronchiectasis, 86 cases were PA positive, accounting for 16.04% (86/536). The results of logistic regression analysis showed that disease course ≥ 12 months, imaging cystic columnar appearance, number of acute exacerbations ≥ 2, and number of hospital admissions ≥ 2 within 1 year were independent risk factors for PA infection in patients with bronchiectasis (OR ≥ 1, P < 0.05). PA showed extremely high resistance rates to cefotaxime (100.00%) and tetracycline (97.67%), followed by moxifloxacin (40.70%), and low resistance to piperacillin/tazobactam (3.49%) and cefoperazone/sulbactam (8.14%). Conclusion Patients with bronchiectasis have a higher infection rate of PA, with a course of ≥ 12 months, cystic columnar imaging, ≥ 2 acute exacerbations, and ≥ 2 hospital admissions within a year as independent risk factors. PA is naturally resistant to cefotaxime and tetracycline, and targeted prevention and treatment measures should be developed in clinical practice to improve patient prognosis.

Key words:Bronchiectasis; Pseudomonas aeruginosa; Risk factor; Drug resistance