CAJ | 학술논문

目的观察需有创通气的慢性阻塞性肺疾病急性加重(AECOPD)患者多耐药菌(MDR)感染发生率、危险因素及其对预后的影响.方法回顾性观察了142例需有创通气的AECOPD患者气道分泌物致病菌谱、MDR发生率,相关危险因素及MDR对预后的影响.结果入选患者114例,社区获得性呼吸道感染传统致病菌39株,占34.2%;MDR 39株,占34.2%.患者年龄、既往气管插管、AECOPD住院频数、COPD严重程度、插管前抗生素治疗不当是MDR的独立危险因素,而糖尿病、长期吸入糖皮质激素(ICS)门诊治疗并非MDR的危险因素.与非MDR组比较,MDR组机械通气时间显著延长(P=0.009)、病死率显著增高(P=0.001).结论严重AECOPD患者MDR感染发生率增高,与患者年龄、COPD严重程度、既往气管插管、插管前抗生素治疗不当有关,MDR导致AECOPD患者机械通气时间延长、病死率增高.
목적 관찰수유창통기적만성조새성폐질병급성가중(AECOPD)환자다내약균(MDR)감염발생솔、위험인소급기대예후적영향.방법 회고성관찰료142례수유창통기적AECOPD환자기도분비물치병균보、MDR발생솔,상관위험인소급MDR대예후적영향.결과 입선환자114례,사구획득성호흡도감염전통치병균39주,점34.2%;MDR 39주,점34.2%.환자년령、기왕기관삽관、AECOPD주원빈수、COPD엄중정도、삽관전항생소치료불당시MDR적독립위험인소,이당뇨병、장기흡입당피질격소(ICS)문진치료병비MDR적위험인소.여비MDR조비교,MDR조궤계통기시간현저연장(P=0.009)、병사솔현저증고(P=0.001).결론 엄중AECOPD환자MDR감염발생솔증고,여환자년령、COPD엄중정도、기왕기관삽관、삽관전항생소치료불당유관,MDR도치AECOPD환자궤계통기시간연장、병사솔증고.
Objective To investigate the prevalence,risk factors and outcomes of multi-drug resistant bacteria(MDR)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)requiring invasive mechanical ventilation.Methods Retrospective study was conducted on the bacteriology of tracheal bronchial aspirates from 142 patients with AECOPD requiring invasive mechanical ventilation,the prevalence of MDR,its relative risk factors and impacts on patient outcomes.Results The big three traditional pathogens causing community acquired respiratory infections only accounted for 34.2% of 114 enrolled patients,39 strains of MDR were identified,accounting for another 34.2%.The patient age,past intubation,severity of COPD,frequency of annual hospital admission due to AECOPD and inappropriate antibiotic treatment were independently risk factors of MDR.Diabetes mellitus,outpatient inhaled corticosteroid treatment were not associated MDR.Compared with patients without MDR,MDR patients had significant prolonged mechanical ventilation and higher mortality.Conclusions The prevalence of MDR is high in severe AECOPD,old age,past intubation,increased severity of COPD,increased frequencv of AECOPD attack and hospital admission,inappropriate antibiotic use are associated with increased prevalence of MDR,which is linked with prolonged mechanical ventilation and higher mortality.