Clinical Focus ›› 2022, Vol. 37 ›› Issue (4): 315-319.doi: 10.3969/j.issn.1004-583X.2022.04.005
Previous Articles Next Articles
Zhu Ying, Shu Qianqian, Chen Fuhui()
Received:
2021-09-22
Online:
2022-04-20
Published:
2022-05-13
Contact:
Chen Fuhui
E-mail:chenfuhui2019@163.com
CLC Number:
Zhu Ying, Shu Qianqian, Chen Fuhui. Clinical characteristics and drug resistance of community-acquired Acinetobacter baumannii pneumonia[J]. Clinical Focus, 2022, 37(4): 315-319.
Add to citation manager EndNote|Ris|BibTeX
URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.04.005
临床资料 | 例数[例(%)] |
---|---|
年龄 | |
<65岁 | 16(36.4) |
≥65岁 | 28(63.6) |
性别 | |
男 | 26(59.1) |
女 | 18(40.9) |
合并症 | |
心脏疾病 | 29(65.9) |
呼吸疾病 | 21(47.7) |
消化系统疾病 | 4(9.1) |
血栓 | 6(13.6) |
糖尿病 | 16(36.4) |
肿瘤 | 10(22.7) |
骨折 | 6(13.6) |
神经系统疾病 | 21(47.7) |
个人史 | |
饮酒史 | 7(15.9) |
吸烟史 | 13(29.5) |
抗生素使用史 | 19(43.2) |
重症肺炎 | |
是 | 16(36.4) |
否 | 28(63.6) |
临床资料 | 例数[例(%)] |
---|---|
年龄 | |
<65岁 | 16(36.4) |
≥65岁 | 28(63.6) |
性别 | |
男 | 26(59.1) |
女 | 18(40.9) |
合并症 | |
心脏疾病 | 29(65.9) |
呼吸疾病 | 21(47.7) |
消化系统疾病 | 4(9.1) |
血栓 | 6(13.6) |
糖尿病 | 16(36.4) |
肿瘤 | 10(22.7) |
骨折 | 6(13.6) |
神经系统疾病 | 21(47.7) |
个人史 | |
饮酒史 | 7(15.9) |
吸烟史 | 13(29.5) |
抗生素使用史 | 19(43.2) |
重症肺炎 | |
是 | 16(36.4) |
否 | 28(63.6) |
临床症状 | 总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 |
---|---|---|---|---|---|
发热 | 18(40.9) | 11(68.8) | 7(25.0) | 8.062 | 0.005 |
乏力 | 10(22.7) | 4(25.0) | 6(21.4) | 0.074 | 1.000 |
肌肉、关节痛 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
畏寒 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
寒战 | 6(13.6) | 4(25.0) | 2(7.1) | 2.757 | 0.169 |
咳嗽 | 36(81.8) | 8(50.0) | 28(100.0) | 17.111 | 0.000 |
咳痰 | 33(75.0) | 9(56.3) | 24(85.7) | 4.714 | 0.067 |
呼吸困难 | 34(77.3) | 11(68.8) | 23(82.1) | 1.040 | 0.456 |
胸闷 | 6(13.6) | 1(6.3) | 5(17.9) | 1.165 | 0.392 |
咯血 | 5(11.4) | 0 | 5(17.9) | 3.223 | 0.141 |
胸痛 | 6(13.6) | 2(12.5) | 4(14.3) | 0.028 | 1.000 |
心悸 | 5(11.4) | 0 | 5(17.9) | 3.223 | 0.141 |
恶心 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
腹痛 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
腹泻 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
呕吐 | 2(4.5) | 1(6.3) | 1(3.6) | 0.168 | 1.000 |
临床症状 | 总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 |
---|---|---|---|---|---|
发热 | 18(40.9) | 11(68.8) | 7(25.0) | 8.062 | 0.005 |
乏力 | 10(22.7) | 4(25.0) | 6(21.4) | 0.074 | 1.000 |
肌肉、关节痛 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
畏寒 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
寒战 | 6(13.6) | 4(25.0) | 2(7.1) | 2.757 | 0.169 |
咳嗽 | 36(81.8) | 8(50.0) | 28(100.0) | 17.111 | 0.000 |
咳痰 | 33(75.0) | 9(56.3) | 24(85.7) | 4.714 | 0.067 |
呼吸困难 | 34(77.3) | 11(68.8) | 23(82.1) | 1.040 | 0.456 |
胸闷 | 6(13.6) | 1(6.3) | 5(17.9) | 1.165 | 0.392 |
咯血 | 5(11.4) | 0 | 5(17.9) | 3.223 | 0.141 |
胸痛 | 6(13.6) | 2(12.5) | 4(14.3) | 0.028 | 1.000 |
心悸 | 5(11.4) | 0 | 5(17.9) | 3.223 | 0.141 |
恶心 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
腹痛 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
腹泻 | 1(2.3) | 0 | 1(3.6) | 0.585 | 1.000 |
呕吐 | 2(4.5) | 1(6.3) | 1(3.6) | 0.168 | 1.000 |
影像学 | 总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 |
---|---|---|---|---|---|
间质改变 | 20(45.5) | 6(37.5) | 14(50.0) | 0.642 | 0.423 |
肺结节 | 17(38.6) | 6(37.5) | 11(39.3) | 0.014 | 0.907 |
磨玻璃影 | 11(25.0) | 4(25.0) | 7(25.0) | 0.585 | 1.000 |
渗出 | 33(75.0) | 10(62.5) | 23(82.1) | 2.095 | 0.169 |
气肿 | 6(13.6) | 2(12.5) | 4(14.3) | 0.028 | 1.000 |
空洞 | 3(6.8) | 2(12.5) | 1(3.6) | 1.278 | 0.543 |
高密度影 | 6(13.6) | 3(18.8) | 3(10.7) | 0.558 | 0.652 |
实变 | 3(6.8) | 3(18.8) | 0 | 5.634 | 0.042 |
胸腔积液 | 24(54.5) | 11(68.8) | 13(46.4) | 2.046 | 0.153 |
斑索 | 15(34.1) | 5(31.3) | 10(35.7) | 0.090 | 0.764 |
纵隔淋巴结肿大 | 10(22.7) | 5(31.3) | 5(17.9) | 0.201 | 0.732 |
网格影 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
双肺受累 | 38(86.4) | 16(100.0) | 22(78.6) | 0.278 | 0.543 |
多形态表现 | 36(81.8) | 14(87.5) | 22(78.6) | 0.546 | 0.689 |
影像学 | 总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 |
---|---|---|---|---|---|
间质改变 | 20(45.5) | 6(37.5) | 14(50.0) | 0.642 | 0.423 |
肺结节 | 17(38.6) | 6(37.5) | 11(39.3) | 0.014 | 0.907 |
磨玻璃影 | 11(25.0) | 4(25.0) | 7(25.0) | 0.585 | 1.000 |
渗出 | 33(75.0) | 10(62.5) | 23(82.1) | 2.095 | 0.169 |
气肿 | 6(13.6) | 2(12.5) | 4(14.3) | 0.028 | 1.000 |
空洞 | 3(6.8) | 2(12.5) | 1(3.6) | 1.278 | 0.543 |
高密度影 | 6(13.6) | 3(18.8) | 3(10.7) | 0.558 | 0.652 |
实变 | 3(6.8) | 3(18.8) | 0 | 5.634 | 0.042 |
胸腔积液 | 24(54.5) | 11(68.8) | 13(46.4) | 2.046 | 0.153 |
斑索 | 15(34.1) | 5(31.3) | 10(35.7) | 0.090 | 0.764 |
纵隔淋巴结肿大 | 10(22.7) | 5(31.3) | 5(17.9) | 0.201 | 0.732 |
网格影 | 3(6.8) | 1(6.3) | 2(7.1) | 0.013 | 1.000 |
双肺受累 | 38(86.4) | 16(100.0) | 22(78.6) | 0.278 | 0.543 |
多形态表现 | 36(81.8) | 14(87.5) | 22(78.6) | 0.546 | 0.689 |
总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 | |
---|---|---|---|---|---|
PSI评分 | |||||
1分 | 1(2.3) | 1(6.3) | 0 | ||
2分 | 8(18.2) | 2(12.5) | 6(21.4) | ||
3分 | 6(13.6) | 0 | 6(21.4) | 7.311 | 0.095 |
4分 | 25(56.8) | 12(75.0) | 13(46.4) | ||
5分 | 4(9.1) | 1(6.3) | 3(10.7) | ||
转归 | |||||
好转 | 41(93.2) | 14(87.5) | 27(96.4)* | ||
未愈 | 2(4.5) | 2(12.5) | 0 | 3.569 | 0.127 |
死亡 | 1(2.3) | 0 | 1(3.6) |
总体 (n=44) | 重症肺炎组 (n=16) | 非重症肺炎组 (n=28) | χ2值 | P值 | |
---|---|---|---|---|---|
PSI评分 | |||||
1分 | 1(2.3) | 1(6.3) | 0 | ||
2分 | 8(18.2) | 2(12.5) | 6(21.4) | ||
3分 | 6(13.6) | 0 | 6(21.4) | 7.311 | 0.095 |
4分 | 25(56.8) | 12(75.0) | 13(46.4) | ||
5分 | 4(9.1) | 1(6.3) | 3(10.7) | ||
转归 | |||||
好转 | 41(93.2) | 14(87.5) | 27(96.4)* | ||
未愈 | 2(4.5) | 2(12.5) | 0 | 3.569 | 0.127 |
死亡 | 1(2.3) | 0 | 1(3.6) |
耐药类型 | 株数 | 占比(%) |
---|---|---|
多重耐药 | 14 | 31.8 |
泛耐药 | 7 | 15.9 |
全耐药 | 1 | 2.3 |
耐碳青霉烯类 | 24 | 54.5 |
耐药类型 | 株数 | 占比(%) |
---|---|---|
多重耐药 | 14 | 31.8 |
泛耐药 | 7 | 15.9 |
全耐药 | 1 | 2.3 |
耐碳青霉烯类 | 24 | 54.5 |
药物 | 耐药 | 敏感 | 中介 | |||||
---|---|---|---|---|---|---|---|---|
株数 | 耐药率(%) | 株数 | 敏感率(%) | 株数 | 中介率(%) | |||
头孢吡肟 | 18 | 40.9 | 20 | 45.5 | 6 | 13.6 | ||
头孢他啶 | 20 | 45.5 | 24 | 54.5 | 0 | 0 | ||
哌拉西林/他唑巴坦 | 24 | 54.5 | 19 | 43.2 | 1 | 2.3 | ||
氨苄西林/舒巴坦 | 19 | 43.2 | 24 | 54.5 | 1 | 2.3 | ||
头孢哌酮/舒巴坦 | 15 | 34.1 | 25 | 56.8 | 4 | 9.1 | ||
阿米卡星 | 15 | 34.1 | 29 | 65.9 | 0 | 0 | ||
庆大霉素 | 21 | 47.7 | 23 | 52.3 | 0 | 0 | ||
妥布霉素 | 15 | 34.1 | 27 | 61.4 | 2 | 4.5 | ||
环丙沙星 | 23 | 52.3 | 21 | 47.7 | 0 | 0 | ||
左氧氟沙星 | 16 | 36.4 | 21 | 47.7 | 7 | 15.9 | ||
亚胺培南 | 23 | 52.3 | 20 | 45.5 | 1 | 2.3 | ||
美罗培南 | 23 | 52.3 | 20 | 45.5 | 1 | 2.3 | ||
多西环素 | 19 | 43.2 | 25 | 56.8 | 0 | 0 | ||
米诺环素 | 4 | 9.1 | 26 | 59.1 | 14 | 31.8 | ||
复方新诺明 | 12 | 27.3 | 32 | 72.7 | 0 | 0 | ||
替加环素 | 0 | 0 | 39 | 88.6 | 5 | 11.4 | ||
多黏菌素 | 5 | 11.4 | 39 | 88.6 | 0 | 0 |
药物 | 耐药 | 敏感 | 中介 | |||||
---|---|---|---|---|---|---|---|---|
株数 | 耐药率(%) | 株数 | 敏感率(%) | 株数 | 中介率(%) | |||
头孢吡肟 | 18 | 40.9 | 20 | 45.5 | 6 | 13.6 | ||
头孢他啶 | 20 | 45.5 | 24 | 54.5 | 0 | 0 | ||
哌拉西林/他唑巴坦 | 24 | 54.5 | 19 | 43.2 | 1 | 2.3 | ||
氨苄西林/舒巴坦 | 19 | 43.2 | 24 | 54.5 | 1 | 2.3 | ||
头孢哌酮/舒巴坦 | 15 | 34.1 | 25 | 56.8 | 4 | 9.1 | ||
阿米卡星 | 15 | 34.1 | 29 | 65.9 | 0 | 0 | ||
庆大霉素 | 21 | 47.7 | 23 | 52.3 | 0 | 0 | ||
妥布霉素 | 15 | 34.1 | 27 | 61.4 | 2 | 4.5 | ||
环丙沙星 | 23 | 52.3 | 21 | 47.7 | 0 | 0 | ||
左氧氟沙星 | 16 | 36.4 | 21 | 47.7 | 7 | 15.9 | ||
亚胺培南 | 23 | 52.3 | 20 | 45.5 | 1 | 2.3 | ||
美罗培南 | 23 | 52.3 | 20 | 45.5 | 1 | 2.3 | ||
多西环素 | 19 | 43.2 | 25 | 56.8 | 0 | 0 | ||
米诺环素 | 4 | 9.1 | 26 | 59.1 | 14 | 31.8 | ||
复方新诺明 | 12 | 27.3 | 32 | 72.7 | 0 | 0 | ||
替加环素 | 0 | 0 | 39 | 88.6 | 5 | 11.4 | ||
多黏菌素 | 5 | 11.4 | 39 | 88.6 | 0 | 0 |
[1] |
Hayes BH, Haberling DL, Kennedy JL. et al. Burden of pneumonia-associated hospitalizations: United States, 2001-2014[J]. Chest, 2018, 153(2):427-437.
doi: 10.1016/j.chest.2017.09.041 URL |
[2] | 蒋钟吉, 吴劲松, 刘雪燕, 等. 深圳某三甲医院2019年ICU病原菌分布及耐药性分析[J]. 中国抗生素杂志, 2021, 46(8):795-799. |
[3] |
Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside[J]. World J Clin Cases, 2014, 2(12):787-814.
doi: 10.12998/wjcc.v2.i12.787 URL |
[4] |
Eveillard M, Kempf M, Belmonte O. et al. Reservoirs of Acinetobacter baumannii outside the hospital and potential involvement in emerging human community-acquired infections[J]. Int J Infect Dis, 2013, 17(10): e802-e825.
doi: 10.1016/j.ijid.2013.03.021 URL |
[5] |
Tacconelli E, Carrara E, Savoldi A. et al. Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis[J]. Lancet Infect Dis, 2018, 18(3):318-327.
doi: S1473-3099(17)30753-3 pmid: 29276051 |
[6] | 瞿介明, 曹彬. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志, 2016, 39(4):253-279. |
[7] | 王明贵, Guan X, He L. 等. 广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J]. 中国感染与化疗杂志, 2017, 17(1):82-92. |
[8] | 赵清贵, 张险峰. 某三甲医院呼吸内科革兰阴性杆菌的耐药情况分析[J]. 国际检验医学杂志, 2021, 42(6):744-746. |
[9] | 刘超, 张丽红. 医院与社区获得性肺炎病原菌分布及耐药性变化趋势[J]. 中国卫生检验杂志, 2017, 27(18):2721-2725. |
[10] |
Davis JS, McMillan M, Swaminathan A. et al. A 16-year prospective study of community-onset bacteremic Acinetobacter pneumonia: Low mortality with appropriate initial empirical antibiotic protocols[J]. Chest, 2014, 146(4):1038-1045.
doi: 10.1378/chest.13-3065 URL |
[11] | Meumann EM, Anstey NM, Currie BJ. et al. Genomic epidemiology of severe community-onset Acinetobacter baumannii infection[J]. Microb Genom, 2019, 5(3):e000258. |
[12] | 2019年全国细菌耐药监测报告[J]. 中国合理用药探索, 2021, 18(3):1-11. |
[13] | Lee CR, Lee JH, Park M. et al. Biology of Acinetobacter baumannii: Pathogenesis, antibiotic resistance mechanisms, and prospective treatment options[J]. Front Cell Infect Microbiol, 2017, 7:55. |
[14] |
Wang Q, Wang Z, Zhang F. et al. Long-term continuous antimicrobial resistance surveillance among Nosocomial Gram-Negative Bacilli in China from 2010 to 2018 (CMSS)[J]. Infect Drug Resist, 2020, 13:2617-2629.
doi: 10.2147/IDR.S253104 pmid: 32801799 |
[15] |
Kengkla K, Kongpakwattana K, Saokaew S. et al. Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: A systematic review and network meta-analysis[J]. J Antimicrob Chemother, 2018, 73(1): 22-32.
doi: 10.1093/jac/dkx368 pmid: 29069421 |
[16] |
Liu J, Shu Y, Zhu F. et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: A systematic review and network meta-analysis[J]. J Glob Antimicrob Resist, 2021, 24: 136-147.
doi: 10.1016/j.jgar.2020.08.021 URL |
[17] |
Delgado-Valverde M, Conejo M, Serrano L. et al. Activity of cefiderocol against high-risk clones of multidrug-resistant Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia[J]. J Antimicrob Chemother, 2020, 75(7): 1840-1849.
doi: 10.1093/jac/dkaa117 pmid: 32277821 |
[18] |
Heaney M, Mahoney MV, Gallagher JC. Eravacycline: The tetracyclines strike back[J]. Ann Pharmacother, 2019, 53(11): 1124-1135.
doi: 10.1177/1060028019850173 pmid: 31081341 |
[19] |
Gordillo Altamirano F, Forsyth JH, Patwa R. et al. Bacteriophage-resistant Acinetobacter baumannii are resensitized to antimicrobials[J]. Nat Microbiol, 2021, 6(2):157-161.
doi: 10.1038/s41564-020-00830-7 pmid: 33432151 |
[20] |
Hetta HF, Al-Kadmy I, Khazaal SS. et al. Antibiofilm and antivirulence potential of silver nanoparticles against multidrug-resistant Acinetobacter baumannii[J]. Sci Rep, 2021, 11(1): 10751.
doi: 10.1038/s41598-021-90208-4 URL |
[1] | Huang Saihu, Long Zhongjie, Wu Shuiyan, Bai Zhenjiang. Clinical characteristics and etiological analysis of severe pneumonia complicated with acute respiratory failure in children before and after COVID-19 [J]. Clinical Focus, 2024, 39(2): 140-143. |
[2] | Yu Zeyu, Lin Xi, Chen Zhanghua, Yang Wei, Chen Zhimin, Zhang Hai. Analysis of risk factors for refractory Mycoplasma pneumoniae pneumonia in children [J]. Clinical Focus, 2024, 39(1): 43-46. |
[3] | Sun Xingxing, Lin Hai. Changes in immune function and prognostic risk factors for severe pneumonia in children [J]. Clinical Focus, 2023, 38(6): 521-525. |
[4] | Cheng Tingting, Qi Caiying, Zhang Xuelian, Xiao Meng, Sui Weihang, Li Xiaoyan, Liu Jianying. Analysis of correlations between serum severe mycoplasma pneumoniae pneumonia level with immunoglobulin E and C-reactive protein in children [J]. Clinical Focus, 2023, 38(5): 433-437. |
[5] | Zhou Dawei, Fei Changdong, Liu Yupeng, Zhang Hualin. Acquired immune deficiency syndrome complicated with severe pneumonia: A case report and literature review [J]. Clinical Focus, 2023, 38(4): 352-355. |
[6] | Zhang Dawei, Li Xin, Sun Guifeng. Mycoplasma pneumoniae infection in Chengdu in 2021: An epidemiological study [J]. Clinical Focus, 2023, 38(3): 237-240. |
[7] | Nie Fang, Luo Jun. Analysis of early risk factors for infectious mononucleosis in children from Chengdu city [J]. Clinical Focus, 2023, 38(11): 1008-1011. |
[8] | Zhang Dong, Wang Zhiyuan, Li Shujun. Changes of vitamin A in children with community-acquired pneumonia and corresponding immune function [J]. Clinical Focus, 2022, 37(7): 623-626. |
[9] | Huang Huayan, Lin Chunguang, Chen Yongdong, Zeng Qiyi, Wu Changru. Clinical characteristics of Delta variant of SARS-CoV-2 of shipmate [J]. Clinical Focus, 2022, 37(4): 311-314. |
[10] | Yu Xin, Liu Zhongyang. Predictive value of lung ultrasonography on adjusted therapeutic regimen for patients with pneumonia [J]. Clinical Focus, 2022, 37(2): 133-136. |
[11] | Zang Jiajia, Gao Yanfeng, Han Shuzhi, Ping Fen. Acute eosinophilic pneumonia in the elderly: A case report and literature review [J]. Clinical Focus, 2022, 37(10): 931-933. |
[12] | Deng Kaibin, Han Liang, Niu Shaoqian, Wang Haiyan, Wang Yanbo, Fu Yang, Wang Qing, Zhan Yang, Fu Xianghua. Effect of optimized treatment approach on acute STEMI patients under the situation of prevention and control of COVID-19 [J]. Clinical Focus, 2021, 36(7): 595-599. |
[13] | Eamran Hossain, Tian Ya, Chen Yuan, Zhang Shaodan, Zhang Huifeng. IPEX syndrome concurrent with gut-origin sepsis: A child patient report and literature review [J]. Clinical Focus, 2021, 36(5): 453-457. |
[14] | Zheng Xiao, Zheng Yonghua, Hu Xiaoyan, Chen Zhanjun, Ji Huaxia, Qian Bao. Changes and clinical significance of serum suPAR, sTREM-1, TNF-α,IL-6 in patients with community-acquired pneumonia [J]. Clinical Focus, 2021, 36(4): 323-327. |
[15] | Cai Mujing, Chen Jingjing, Huang Rukun, Cai Xiaoni, Zheng Ruoxian. Epidemiological characteristics, underlying diseases and treatments of elderly hospitalized patients with pneumonia [J]. Clinical Focus, 2021, 36(3): 229-232. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||