Distribution And Drug Resistance Of Pathogens In Chronic Kidney Disease Complicated With Pulmonary Infection

Objective: to analyze the distribution and drug resistance of pathogens in patients with CKD complicated with pulmonary infection in nephrology department,so as to provide basis for rational use of antibiotics in clinical treatment of CKD complicated with pulmonary infection and reduce the production of multi-drug resistant bacteria.Methods: the data of 642 patients with CKD complicated with pulmonary infection andsputum culture positive in the Department of Nephrology of Yijishan Hospital of Southern Anhui Medical College from October 2010 to October 2019 were collected and analyzed retrospectively.The types and distribution of pathogens of CKD complicated with pulmonary infection and the drug resistance of main pathogens were analyzed.The species and distribution characteristics of multi-drug-resistant bacteria were statistically analyzed.According to the drug resistance of the patients,the patients were divided into multi-drug-resistant bacteria infection group and non-multi-drug-resistance bacteria infection group.Analyze whether there is statistical significance in sex and age between multi-drug resistance bacteria infection group and non-multi-drug resistance bacteria infection group.Results: after eliminating the repeated strains of the same patients,a total of 719 strains of pathogenic bacteria were detected,of which 671(93.32%)were Gram-negative bacteria,mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae,Escherichia coli,Acinetobacter baumannii;the proportion of Gram-negative bacteria increased year by year,related to the increasing proportion of Klebsiella pneumoniae and Enterobacter cloacae.The results of drug sensitivity showed that the drugs with high sensitivity were β-lactamase inhibitors,amikacin and carbapenem,and the drugs with high resistance were ampicillin and cefazolin.There were 48 strains(6.68%)of gram-positive bacteria,mainly Staphylococcus aureus,and the detection rate of MRSA was 1.53%.No strains resistant to linezolid,vancomycin,nitrofurantoin,quinuprotin /dafoptin and rifampicin were found.A total of 391 strains of multidrug resistant bacteria(MDRO)were detected,mainly Pseudomonas aeruginosa,Acinetobacter baumannii and Escherichia coli.Among Enterobacteriaceae bacteria,the detection rate of extended-spectrum β-lactamase-producing bacteria(ESBLs)was 18.93%,mainly Escherichia coli and Klebsiella pneumoniae.The resistance rate of ESBLs-producing bacteria to quinolones,cephalosporins,aztreonam,ampicillin / sulbactam and other antibiotics was higher than that of non-ESBLs-producing bacteria.There were 16 strains of Enterobacteriaceae(CRE),mainly Enterobacter cloacae and Klebsiella pneumoniae,9 strains of Pseudomonas aeruginosa(CRPA)and 5 strains of Acinetobacter baumannii(CRAB).There was no significant difference in gender between multidrug resistant bacteria infection group and non-multidrug resistance bacteria infection group,but there was significant difference in age ≥ 60 years old.Patients with MDRO infection were more concentrated between 40 and 80 years old,accounting for 73.33%.Conclusion: the main pathogens of CKD complicated with pulmonary infection are gram-negative bacteria,and the pathogens have varying degrees of resistance to commonly used clinical antibiotics,and the detection rate of multiple drug-resistant bacteria is 54.38%.The form of drug resistance of pathogens in patients with CKD complicated with pulmonary infection is severe.Regular monitoring of bacterial drug resistance can effectively guide clinical rational drug use.