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目的了解重度慢性阻塞性肺疾病(COPD)患者革兰阴性多药耐药菌(MDRB)下呼吸道感染的易感因素、病原菌分布,为预防和控制多药耐药菌株产生提供依据。方法选取2013年1月-2015年11月医院呼吸内科277例革兰阴性下呼吸道感染的重度慢性阻塞性肺疾病住院患者,分析MDRB感染率、易感因素和病原菌分布。结果重度COPD患者MDRB感染率为28.52%,易感因素包括医院获得性感染、合并糖尿病、低白蛋白血症、侵袭性操作、第三代头孢菌素、使用氟喹诺酮类药物、联合应用抗菌药物≥3d;79株革兰阴性多药耐药菌主要为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌。结论应加强对重度慢性阻塞性肺疾病患者革兰阴性多药耐药菌下呼吸道感染病原菌的监测与控制,根据药敏结果合理选用抗菌药物,以减少耐药菌株产生。
Objective To understand the predisposing factors and pathogens of Gram-negative multi-drug resistant bacteria (MDRB) in patients with severe chronic obstructive pulmonary disease (COPD), and to provide basis for preventing and controlling multidrug resistant strains. Methods From January 2013 to November 2015, 277 hospitalized patients with severe chronic obstructive pulmonary disease of Gram-negative lower respiratory tract infection were analyzed retrospectively. The prevalence of MDRB infection, susceptibility factors and distribution of pathogens were analyzed. Results The prevalence of MDRB in patients with severe COPD was 28.52%. The predisposing factors included nosocomial infections, diabetes mellitus, hypoalbuminemia, invasive procedures, third generation cephalosporins, fluoroquinolones, antimicrobial agents ≥ 3d; 79 Gram-negative multidrug-resistant bacteria mainly Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli. Conclusion The monitoring and control of pathogens in respiratory tract infections of Gram-negative multidrug-resistant bacteria in patients with severe chronic obstructive pulmonary disease should be strengthened. According to the drug susceptibility results, rational selection of antimicrobial agents to reduce the generation of drug-resistant strains.