Investigation On Risk Factors Of Respiratory System Infection And Evaluation Of The Effect Of Regulation On The Clinical Application Of Antibacterial Drugs

Respiratory tract infections include upper respiratory tract infection and lower respiratory tract infections (LRTI). LRTI usually include chronic bronchitis, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease,secondary infection of bronchial expansionand pneumonia,etc., which can be caused by a variety of pathogenic microorganisms. Respiratory tract infections are common infectious disease in clinic and it is one of the main diseases that threaten human health, and account for the highest morbidity and motality of all kinds of infectious diseases. Many scholars have done a lot of research on the risk factors of respiratory infection in patients with tracheal intubation under general anesthesia, patients with traumatic brain injury, patients with tracheal intubation and patients required intensive care, the main risk factors including long duration of anesthesia, intubation pathway, postoperative extubation time, intubation too deep, unskilled intubation, extubation indication of incomplete and extubation delay, ICU stay, long duration of hospitalization, mechanical ventilation, the ultilazation of antibacterial drugs were more than or equal to 7 days, application with imipenem and with more than three antibiotics before the infection occurrence, and so on. These risk factors account for respiratory nosocomial infection had been reported, while little data on risk factorsof respiratory infection in community is avaivable. Here weconducted a study to evaluate the risk factors on patients associated with respiratory infection in community.Klebsiella pneumoniae and Pseudomonas aeruginosa are the main opportunistic pathogens of respiratory infections. With the extensive application of broad-spectrum antibiotics, a large number of multi-resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa were detected. In 2011, the detection rate of ESBLs in Klebsiella pneumoniae was 38.5%(2668/6937) in China, which was increased from 26.1% to 64.7% than 2010. Mohnarin illustrated that 39.4% Pseudomonas aeruginosa strainswith multi-resistant charactristics were detected in 2011-2012. The production of super extended spectrum beta lactamase (ESBLs) and plasmid mediated cephalosporin (AmpC) enzyme are the main causation of.antibiotics resistance gained by Klebsiella pneumoniae, which due to the widespread use of the third and the forth generation cephalosporins Mena A and Lister PD have reported that Pseudomonas aeruginosa can obtained resistance genesthrough chromosome mutation and plasmid transduction, and the resistance gene can be inherited to the next generation. Pseudomonas aeruginosa is shown to produce the following enzymes:serine beta lactamases (PsE, CARB and TEM), extended spectrum beta lactamases (ESBL, including TEM, SHV, CTX-M, PER, VEB, CES and IBC), metallo beta lactamase (IMP, VIM, SPM and GIM) and carbapenemase (KPC). These enzymes make the Pseudomonas aeruginosa resitstant to Aeromonas of cephalosporin, piperacillin Xilin and carbapenem.Antibacterial agents is an important drugthat widely used in clinical infectious diseases from the discovery of penicillin in 1941, New varieties of antibacterial agents have emerged over the decades, there have been hundreds of applications in clinical treatment for effectively controlled the various infectious diseases. However, with the widely use of antibiotics, it has been found that there were many problems about the abuse and irrational use of antibiotics, resulting in the disorder of bacterial flora, the production of bacterial drug resistant strains, and the damage of tissue and organ function,which bring the new disease and harm to the patient at the same time also aggravate the economic burden of society and patients.Antibacterial drug abuse problem has attracted great attention of medical experts all over the world. WHO regarded that the irrational use of antibacterial agents had become a global public health problem and turned to be the common challenge within the world. In recent years, the relevant government departments to curb the abuse of antimicrobial drugs carring on the introduction of a series of regulatory rules and guidelines and other regulatory documents, launched a series of special treatment activities.In order to effectively control bacterial drug resistance, to ensure the quality and safety of medical care, combined with the actual conditions of our hospital, we conducted a special rectification activities scheme according to the Ministry of health "antibacterial administrative measures for clinical use of drugs" (Ministry of health No. eighty-fourth) by the end of 2012t The surveillance of antimicrobial drug resistance of Klebsiella pneumoniae and Pseudomonas aeruginosa strains was performed in patients with respiratory infections during the study period to evaluate the implementation effect of the special treatment program for the clinical application of antimicrobial agents.Objective Data analysis of patients with community-acquired respiratory infectious disease in our hospital for better understanding the susceptible factors of respiratory infections and evulating the implementation effect of antibacterial drug clinical application of special rectification program thatperformed in our hospital. To investigate the sensitive to antibiotics of Klebsiella pneumonia and Pseudomonas aeruginosa strains in the department of respiratory medicine and provide a detail information to guide clinicians rationally use of antimicrobial agents and make empirical anti infective therapy, so as to effectively control the bacterial resistance to ensure medical quality and medical safety.Methods Electronic medical record query system was used in this study for collecting and analyzing the medical data (gender, age, smoking history and medical conditions) of patients with respiratory infection in community from 2012 to 2015.Qualified sputum samples or bronchoalveolar lavage fluid were collected from community patients who admitted to reapiratory department of internal medicine and diagnosed as respiratory infection, according to the relevant requirements of the "National Clinical Laboratory Procedures" and the CLSI standards. The pathogenic bacteria was isolated and identified in the same time, as well as " drug susceptibility tests were performed on the Klebsiella pneumoniae and Pseudomonas aeruginosa isolated strains. The bacterial identification was carried out by using VITEK 2 COMPACT automatic bacterial analyzer, and drug sensitivity test was carried out using VITEK 2 COMPACT automatic bacteria analyzer combined with K-B (Kirby.Bauey) paper diffusion method. A retrospective analysis was made on the results of drug resistance of Klebsiella pneumoniae and Pseudomonas aeruginosa strains isolated from patientsof whose repeated strains isolated from sputum samples during the same hospitalization were discarded. Excel software was used to built the database and the data were collected to analyze the variation of drug resistance of Klebsiella pneumoniae and Pseudomonas aeruginosa before and after the intervention program carried out.Results Klebsiella pneumoniae and Pseudomonas aeruginosa from 2012 to 2015 of respiratory infection in respiratory department of internal medicine patients gender difference, male patients were more than female patients, the average age of male patients were infected with Pseudomonas aeruginosa for more than 65 years old.2012 years to 2015 of the respiratory system with smoking more than 10 years the proportion respectively.69.6%(48/69),67.2%(39/58),70.8%(34/48) and 70.9 (39/55), female patients with smoking history of more than 10 years the proportion is less than 5%; male patients with diabetes accounted for 30.4%(21/69),32.8%(19/ 58),31.2%(15/48) and 23.6%(13/55), female patients with diabetes accounted for 32.7%(16/49),29.5%(13/44),25%(10/40) and 27.3%(9/33) male patients with Klebsiella pneumoniae.2012 to 2015 respiratory system infection has more than 10 years history of smoking accounted for 68.3%(28/41) 74.4%(29/39). And 70.9% 39/55 and 77.3% 51/66, female patients with smoking history of more than 10 years, the proportion of were less than 5.0%; male patients with diabetes proportion respectively 29.2%(12/41),33.3%(13/39),32.7%(were 32.7% and 39.4% 26/66, female patients with diabetic disease proportion respectively for 24.1%(7/29), 37.5%(6/16),34.6%(9/26) and 36.4%(8/22).There were 70,56,81 and 88 cases of Klebsiella pneumoniae related respiratory infection, respectively detected from 2012 to 2015 inthe respiratory department of internal medicine of our hospital.Before theimplement of intervention program(2012), the detection rate of Klebsiella pneumoniae producing extended spectrum beta lactamase (ESBLs+) in respiratory infectione was 28.6% (20/70); while the detection rate respectively decrease to 21.4%(12/56),11.1%(9/81) and 12.5%(11/88) after the intervention program carried out in 2013-2015As the program measures implementation and continuous improvement, the Department of respiratory isolates of Klebsiella pneumoniae to antibacterial drug sensitivity improvement in.2013 compared with 2012, the bacteria showed different degrees of increase the sensitivity of 19 antimicrobial drugs commonly used in clinic, including of cefepime, levofloxacin, Sha The stars and the sensitivity to ampicillin/sulbactam increased significantly (P<0.05, X2>3.84) between.2014 and 2012, the bacteria on clinical antimicrobial susceptibility increases, the sensitivity to levofloxacin increased significantly (P<0.05, X2>3.84), to cefazolin, cefuroxime, cefotaxime match oxime, aztreonam, gentamicin, ceftriaxone, ampicillin/sulbactam, ceftazidime, cefepime and nitrofurantoin susceptibility of 10 antimicrobial agents increased significantly (P<0.01, X2>6.63) between.2015 and 2012, the bacteria of ceftriaxone, cefuroxime, cefotaxime oxime and match nitrofurantoin sensitivity of 4 drugs significantly improved (P<0.05, X2>3.84); to cefazolin, ceftazidime, cefepime, aztreonam, gentamicin and ampicillin/sulbactam susceptibility of 6 antimicrobial agents increased significantly (P<0.01, X2>6.63).3 years after the intervention (2013 to 2015) were two Two comparison of the bacteria in the clinical use of the 19 kinds of antimicrobial susceptibility of the difference is not statistically significant.From 2012 to 2015, strains of Pseudomonas aeruginosa isolated from respiratory Respiratory Department of internal medicine patients in the community were 118 strains,102 strains, the detection rate of 11.9% multi drug resistant Pseudomonas aeruginosa 89 strains and 88.2012 patients in respiratory department of internal medicine respiratory infection (14/118); the project intervention (2013～2015), multi drug resistant Pseudomonas aeruginosa were detected in 6.9%(7/102),4.5%(4/89) and 3.4%(3/88). The scheme with various measures of implementation and continuous improvement, the bacteria showed different degrees of increase in.2013 compared with 2012 to 14 kinds of antimicrobial susceptibility of clinical commonly used, the sensitivity of P. Pseudomonas to cotrimoxazole and cefepime significantly increased (P<0.05,X2>3.84); to amikacin, cefotaxime, gentamicin and tobramycin susceptibility of 4 antimicrobial agents increased significantly (P<0.01, X2>6.63.) 2014and 2012 In comparison, the sensitivity to imipenem increased significantly (P<0.05,X2>3.84); to piperacillin, piperacillin/tazobactam, ciprofloxacin, levofloxacin, meropenem and amikacin and ceftazidime, cefepime and tobramycin 9 antimicrobial drug sensitivity was improved (P<0.01, X2>6.63).2015 compared with 2012, Pseudomonas aeruginosa to maintain a high sensitivity to the clinical commonly used antibiotics, sensitive to cotrimoxazole increased significantly (P<0.05, X2>3.84); to imipenem, meropenem, gentamicin, amikacin and ceftazidime. Cefepime, piperacillin, piperacillin/tazobactam, tobramycin, ciprofloxacin and levofloxacin sensitivity increased significantly (P<0.01, X2>6.63). Between 2015 and 2012, Pseudomonas aeruginosa to maintain a high sensitivity to the clinical commonly used antibiotics, sensitive to cotrimoxazole increased significantly (P<0.05, X2>3.84); to imipenem, meropenem, gentamicin, amikacin, ceftazidime, cefepime, piperacillin, piperacillin piperacillin/tazobactam, tobramycin, ciprofloxacin and levofloxacin sensitivity increased significantly (P<0.01, X2>6.63). 3 years after the intervention (2013 to 2015) were two two, Pseudomonas aeruginosa to ampicillin/sulbactam, cotrimoxazole, amikacin, levofloxacin and tobramycin the sensitivity, ceftazidime, cefepime and ceftriaxone difference was not statistically significant (P>0.05, X2<3.84).2014 compared with 2013, the sensitivity of Pseudomonas aeruginosa to levofloxacin and imipenem increased significantly (P<0.05, X2>3.84); to cefepime, piperacillin, piperacillin/tazobactam, ciprofloxacin, meropenem and sensitivity was improved (P<0.01, X2>6.63); 2015 and 2013 comparison, the sensitivity of Pseudomonas aeruginosa to ciprofloxacin and gentamicin was significantly increased (P<0.05, X2>3.84); to imipenem, meropenem, piperacillin and pethidine piperacillin/tazobactam sensitivity significantly improve (P<0.01, X2>6.63); 2015 and 2014 comparison, the sensitivity of Pseudomonas aeruginosa to gentamicin significantly increased (P<0.01, X2>6.63). With the antimicrobial drugs in clinical application of special rectification measures of intervention and continuous improvement, respiratory medicine sense of specimen submission rate increased year by year, the antibiotic use rate and use the strength decreased year by year.From 2012 to 2015, the average number of days of hospitalization in patients with respiratory department of internal medicine was 9.38 days,8.50 days,7.90 days and 7.89 days.Conclusions1, Respiratory tract infections occurred in elder male patients more than females.. Aged, smoking and diabetes are predisposing factors for respiratory tract infectious diseases2, With the implementation and continuous improvement ofspecial rectification activities program for the clinical application of antibacterial agents, the sensitivity to clinical antimicrobial drugs of Klebsiella pneumoniae (and Pseudomonas aeruginosa) that isolated from sputum or bronchoalveolar lavage fluid samples of patients with respiratory infections was (were) significantly increased. The infection rate of the specimen increased year by year, the usage of antimicrobial drugs and use intensity decreased year by year.3, The average hospitalization days of patients in respiratory department were gradually decreased year by year after the intervention of special rectification activities program for the clinical application of antibacterial agentsThe average hospitalization days of patients in respiratory department decreasedto 0.8,1.48 and 1.49 days respectively 2013-2015.