Retrospective Analysis Of MDRB In Lower Respiratory Tract Infections

Objective:To investigate the epidemiological data of patients with lower respiratory tract multidrug resistant infection in our hospital by retrospective analysis,and to study the incidence rate and risk factors of multidrug resistant infection,distribution and composition ratio of multidrug resistant strains,as well as the resistance to certain antibiotics.And provide evidence for prevention and controlling measure of MDRB infections.Methods:A total of 116 clinical datas from patients with lower respiratory tract multidrug resistant infection in our hospital were collected from November 2012 to December 2013.All dates were analyzed with SPSS 17.0 software,the count data was represented with rate or composition ratio,and the difference between the two groups was compared by chi square test.In this study,the possible risk factors with statistical significance was screened out with the single factor analysis,and then the risk factors closed to the MDRB infection was determined with the logistic regression analysis,the differences was statistical significant when P<0.05.Results:Totally 116 patients with lower respiratory tract infection were collected in our hospital from November 2012 to December 2013,the patients mainly came from the intensive care unit,accounting for 38.79%(45/116),27.59% came from department of neurology(32/116),14.66% came from department of respiration internal medicine(17/116).And There were 802 resistant strains isolated from the sputum specimens of these patients.Among that,there were 799 gram-negative bacteria,accounting for 99.6%,gram-negative bacteria become the main pathogen of lower respiratory tract infection.The 3 strains of gram-positive bacteria were all resistant to methicillin resistant Staphylococcus aureus(MRSA).The community acquired pneumonia in 35 cases,accounting for 4.36%(35/802),hospital acquired pneumonia in 767 cases,accounting for 95.64%(767/802).The top three of the resistant bacteria were Pseudomonas aeruginosa,264 strains,accounting for 32.92%(264/802),Acinetobacter baumannii,248 strains,accounting for 30.92%(248/802),154 strains of Klebsiella penumoniae,accounting for 19.20%(154/802),followed by 75 strains of stenotrophomonas maltophilia,accounting for 9.35%,54 strains of Escherichia coli,accounting for 6.73%,4 strains of Burkholderia cepacia,accounting for 0.50%.Among 802 strains,there were 731 multidrug resistant strains,accounting for 91.15%.Among the multidrug resistant strains,the most detected strain was Acinetobacter baumannii 247,accounting for 33.79%(247/731),then 213 strains of Pseudomonas aeruginosa,accounting for 29.14%(213/731),137 strains of Klebsiella penumoniae,accounting for 18.74%,75 strains of stenotrophomonas maltophilia,accounting for 10.26%(75/731),52 strains of Escherichia coli,accounting for 7.11%(52/731).Burkholderia cepacia in 4 strains,accounting for 0.55(4/731),3 strains of Staphylococcus aureus,accounting for 0.41(3/731).Drug resistance analysis showed that the resistance of Pseudomonas aeruginosa to piperacillin/tazobactam and amikacin was the lowest,61.74% and 66.29% respectively.The resistance of Acinetobacter baumannii to levofloxacin was the lowest(52.02%),while more than 90% to other antibiotics.The resistance of stenotrophomonas maltophilia to minocycline was the lowest(0%).The resistance of Burkholderia cepacia to ceftazidime,cefepime and levofloxacin were all 0%.The resistance of Klebsiella penumoniae to trimethoprim/sulfamethoxazole was 35.71%.The resistance of Escherichia coli to piperacillin/tazobactam,cefotetan and imipenem was the lowest(1.85%).The resistance of Staphylococcus aureus to nitrofurantoin,vancomycin and tigecycline were 0%.Single factor analysis showed that ESBL producing,infection combined with other bacteria and quinolone antibiotics used previously were statistically significant to lower respiratory tract infection caused by multidrug resistant bacteria.Multiple logistic reqression analysis indicated that quinolone antibiotics used previously and combined with diabetes were the independent risk factors to lower respiratory tract infection caused by multidrug resistant bacteria.Conclusion:1、There were 802 resistant strains isolated from the sputum specimens of the patients with lower respiratory tract multidrug resistant infection from November 2012 to December 2013,and the multidrug resistant bacteria accounted for the majority,which became the main pathogens in lower respiratory tract infection.Among the multidrug resistant bacteria,the most detected strain was Acinetobacter baumannii.The drug resistant strains mainly came from the intensive care unit,department of neurology,department of respiration internal medicine.The detection of drug resistance is very common,and which is very serious.2、Our study indicated that quinolone antibiotics used previously and combined with diabetes were the independent risk factors to lower respiratory tract infection caused by multidrug resistant bacteria.Therefore,the clinical prevention of MDRB infection should be carried out from the above two aspects,in addition,we must strengthen the management of antimicrobial drugs and use the antimicrobial agents rationally.