中国现代医学杂志2026，Vol.36Issue(3)：84-90,7.DOI:10.3969/j.issn.1005-8982.2026.03.013
慢性阻塞性肺疾病合并呼吸衰竭患者院内感染病原菌的耐药特征与危险因素分析
Analysis of resistance characteristics and risk factors of nosocomial pathogens in patients with chronic obstructive pulmonary disease complicated by respiratory failure
摘要
Abstract
Objective To clarify the drug resistance characteristics of nosocomial pathogenic bacteria and their related risk factors in patients with chronic obstructive pulmonary disease(COPD)complicated by respiratory failure,so as to optimize clinical infection management and treatment strategies for this population.Methods A total of 198 patients with COPD complicated by respiratory failure admitted to our hospital from July 2021 to July 2024 were retrospectively enrolled.They were divided into the pneumonia group(86 cases)and non-pneumonia group(112 cases)based on the occurrence of ventilator-associated pneumonia.Laboratory indicators were compared between the two groups.The distribution and drug resistance of pathogenic bacteria in the pneumonia group were statistically analyzed.multivariate logistic regression model analysis of influencing factors for hospital-acquired infections in COPD patients with respiratory failure.Results Serum IL-6,TNF-α,AAG,SAA,PCT,TLR4,and NF-κB levels in the pneumonia group were significantly higher than those in the non-pneumonia group(P<0.05).A total of 237 pathogenic strains were detected in the pneumonia group,mostly Gram-negative bacteria(59.49%),with Pseudomonas aeruginosa accounting for the highest proportion(35.46%);Gram-positive bacteria accounted for 22.36%,mainly Staphylococcus aureus(52.83%).Main Gram-negative bacteria(Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae)had relatively high resistance to cephalosporins(e.g.,cefotaxime,cefepime)but low resistance to meropenem and imipenem.Main Gram-positive bacteria(Staphylococcus aureus,Staphylococcus haemolyticus)showed high resistance to erythromycin and ampicillin,but low resistance to vancomycin and linezolid.Multivariate Logistic regression analysis indicated that high IL-6[(O^R)=3.436(95%CI:1.097,10.762)],TNF-α[(O^R)=4.398(95%CI:1.023,18.908)],AAG[(O^R)=3.316(95%CI:1.068,10.296)],SAA[(O^R)=2.984(95%CI:1.135,7.845)],PCT[(O^R)=2.801(95%CI:1.047,7.493)],TLR4[(O^R)=2.801(95%CI:1.047,7.493)],and NF-κB[(O^R)=4.066(95%CI:1.184,13.963)]levels were all independent risk factors for nosocomial infection in COPD patients with respiratory failure(P<0.05).Conclusion Gram-negative bacteria are the main nosocomial pathogens in patients with COPD complicated by respiratory failure,with significant drug resistance.Early and accurate identification of pathogens and analysis of their drug resistance are crucial for formulating effective anti-infection treatment strategies.关键词
慢性阻塞性肺疾病/呼吸衰竭/院内感染/耐药性/病原菌Key words
chronic obstructive pulmonary disease/respiratory failure/nosocomial infections/resistance/pathogens分类
医药卫生引用本文复制引用
高晓雪,刘保珠,李燕,张晓雷,刘洁,曹珊..慢性阻塞性肺疾病合并呼吸衰竭患者院内感染病原菌的耐药特征与危险因素分析[J].中国现代医学杂志,2026,36(3):84-90,7.基金项目
北京市自然科学基金(No:7232284) （No:7232284）
