摘要
目的分析呼吸重症科下呼吸道感染患者常见病原菌流行病学特征,为临床诊断和流行病学调查提供依据。方法收集2019—2020年新乡市3家三级甲等医院呼吸重症科下呼吸道感染患者的合格痰样本和肺泡灌洗液样本2382例,采用环介导等温扩增(LAMP)法和细菌培养法检测病原菌,分析2种方法病原菌检测结果的一致性。比较不同年龄、性别患者病原菌分布差异,并分析不同季节不同病原菌阳性率差异。采用纸片扩散法进行药物敏感性试验。结果2382例样本中,检出率居前3位的病原菌为鲍曼不动杆菌(19.40%)、耐甲氧西林金黄色葡萄球菌(17.25%)和肺炎克雷伯菌(13.98%)。<20岁人群耐甲氧西林金黄色葡萄球菌和流感嗜血杆菌的阳性率最高,鲍曼不动杆菌的感染对象主要为≥60岁人群,不同年龄、性别患者下呼吸道感染病原菌总阳性率差异有统计学意义(P<0.001)。除肺炎克雷伯菌、鲍曼不动杆菌和流感嗜血杆菌外,其他病原菌阳性率在各个季节的差异均有统计学意义(P<0.05)。男性患者和女性患者感染率最高的病原菌均为鲍曼不动杆菌;金黄色葡萄球菌、铜绿假单胞菌和嗜麦芽窄食单胞菌等病原菌的感染率在不同性别患者中差异均无统计学意义(P>0.05)。不同革兰阴性杆菌的耐药情况存在差异。LAMP法和细菌培养法检测结果的一致性较差(Kappa值为0.221,P<0.001),其中检测肺炎克雷伯菌的Kappa值为0.408(P<0.001)。结论呼吸重症科患者下呼吸道感染主要的病原菌是鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌;不同病原菌在不同季节和不同性别中的感染率存在差异。LAMP法在下呼吸道感染病原菌的筛查中起重要作用。
Objective To investigate the pathogenic and epidemiological characteristics of patients with lower respiratory tract infection in respiratory intensive care unit,and to provide a reference for clinical diagnosis and epidemiological investigation.Methods A total of 2382 sputum and alveolar lavage fluid specimens were collected from the patients with lower respiratory tract infection in respiratory intensive care units of 3 Grade A Class 3 hospitals in Xinxiang from 2019 to 2020.The pathogens were determined by loop-mediated isothermal amplification(LAMP)and bacterial culture methods.The consistency of 2 methods was evaluated.The pathogen distribution with different ages and between females and males was evaluated.The positive rate with different seasons was evaluated.The drug susceptibility was analyzed by disk diffusion method.Results Among the 2382 specimens,the main pathogens were Acinetobacter baumannii(19.40%),methicillin-resistant Staphylococcus aureus(17.25%)and Klebsiella pneumoniae(13.98%).Methicillin-resistant Staphylococcus aureus and Haemophilus influenza were prevalent in the population<20 years old.Acinetobacter baumannii was mainly infected the population≥60 years old.The total positive rates of pathogens in patients with lower respiratory tract infection with different ages and sex had statistical significance(P<0.001).Except for Klebsiella pneumoniae,Acinetobacter baumannii and Haemophilus influenza,the difference of the other pathogens in each season was statistically significant(P<0.05).Acinetobacter baumannii was the pathogen with the highest infection rate in male and female patients,but the infection rates of Staphylococcus aureus,Pseudomonas aeruginosa and Stenotrophomonas maltophilia showed no statistical significance in male and female patients(P>0.05).The drug resistance of different Gram-negative bacilli had difference.The consistency between LAMP and bacterial culture methods was poor(the Kappa value was 0.221,P<0.001)The Kappa value for Klebsiella pneumoniae was 0.408(P<0.001).Conclusions The pathogens with the highest determination rate in lower respiratory tract infection among respiratory intensive care unit patients are Acinetobacter baumannii,followed by methicillin-resistant Staphylococcus aureus,Klebsiella pneumoniae and Pseudomonas aeruginosa,while the infection rates of different pathogens differ with different seasons and between males and females,and LAMP plays a role in screening lower respiratory tract pathogens.
作者
任燕飞
张敏
杨涛
李荣凯
梁新
REN Yanfei;ZHANG Min;YANG Tao;LI Rongkai;LIANG Xin(The Fifth Clinical College of Xinxiang Medical College,Xinxiang 453000,Henan,China;Xinxiang First People's Hospital,Xinxiang 453000,Henan,China)
出处
《检验医学》
CAS
2023年第2期157-162,共6页
Laboratory Medicine
基金
新乡市第一人民医院科研项目(y1917)。
关键词
呼吸重症科
下呼吸道感染
病原菌
耐药性
环介导等温扩增
Respiratory intensive care unit
Lower respiratory tract infection
Pathogen
Drug resistance
Loop-mediated isothermal amplification
