Analysis of pathogenic epidemiology of patients with lower respiratory tract infection in respiratory intensive care unit

doi:10.3969/j.issn.1673-8640.2023.02.011

Abstract

Abstract:

Objective To investigate the pathogenic and epidemiological characteristics of patients with lower respiratory tract infection in respiratory intensive care unit，and to provide a reference for clinical diagnosis and epidemiological investigation. Methods A total of 2 382 sputum and alveolar lavage fluid specimens were collected from the patients with lower respiratory tract infection in respiratory intensive care units of 3 Grade A Class 3 hospitals in Xinxiang from 2019 to 2020. The pathogens were determined by loop-mediated isothermal amplification（LAMP） and bacterial culture methods. The consistency of 2 methods was evaluated. The pathogen distribution with different ages and between females and males was evaluated. The positive rate with different seasons was evaluated. The drug susceptibility was analyzed by disk diffusion method. Results Among the 2 382 specimens，the main pathogens were Acinetobacter baumannii（19.40%），methicillin-resistant Staphylococcus aureus（17.25%） and Klebsiella pneumoniae（13.98%）. Methicillin-resistant Staphylococcus aureus and Haemophilus influenza were prevalent in the population <20 years old. Acinetobacter baumannii was mainly infected the population ≥60 years old. The total positive rates of pathogens in patients with lower respiratory tract infection with different ages and sex had statistical significance（P<0.001）. Except for Klebsiella pneumoniae，Acinetobacter baumannii and Haemophilus influenza，the difference of the other pathogens in each season was statistically significant（P<0.05）. Acinetobacter baumannii was the pathogen with the highest infection rate in male and female patients，but the infection rates of Staphylococcus aureus，Pseudomonas aeruginosa and Stenotrophomonas maltophilia showed no statistical significance in male and female patients（P>0.05）. The drug resistance of different Gram-negative bacilli had difference. The consistency between LAMP and bacterial culture methods was poor （the Kappa value was 0.221，P<0.001）The Kappa value for Klebsiella pneumoniae was 0.408（P<0.001）. Conclusions The pathogens with the highest determination rate in lower respiratory tract infection among respiratory intensive care unit patients are Acinetobacter baumannii，followed by methicillin-resistant Staphylococcus aureus，Klebsiella pneumoniae and Pseudomonas aeruginosa，while the infection rates of different pathogens differ with different seasons and between males and females，and LAMP plays a role in screening lower respiratory tract pathogens.

Key words: Respiratory intensive care unit, Lower respiratory tract infection, Pathogen, Drug resistance, Loop-mediated isothermal amplification

CLC Number:

R446.1

REN Yanfei, ZHANG Min, YANG Tao, LI Rongkai, LIANG Xin. Analysis of pathogenic epidemiology of patients with lower respiratory tract infection in respiratory intensive care unit[J]. Laboratory Medicine, 2023, 38(2): 157-162.

Figures/Tables 6

References 17

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病原菌	<20岁（21例）		20~39岁（162例）		40~59岁（444例）		≥60岁（1 755例）		合计		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
肺炎链球菌	1	4.76	11	6.79	9	2.03	54	3.08	75	3.15	9.085	0.028
金黄色葡萄球菌	4	19.05	6	3.70	18	4.05	126	7.18	154	6.47	13.290	0.004
耐甲氧西林金黄色葡萄球菌	6	28.57	18	11.11	51	11.49	336	19.15	411	17.25	20.907	<0.001
大肠埃希菌	0	0	0	0	21	4.73	66	3.76	87	3.65	8.460	0.037
肺炎克雷伯菌	3	14.29	3	1.85	40	9.01	287	16.35	333	13.98	37.161	<0.001
铜绿假单胞菌	3	14.29	6	3.70	39	8.78	195	11.11	243	10.20	10.408	0.015
鲍曼不动杆菌	2	9.52	12	7.41	63	14.19	384	21.88	462	19.40	30.879	<0.001
嗜麦芽窄食单胞菌	3	14.29	0	0	12	2.70	119	6.78	134	5.63	24.178	<0.001
流感嗜血杆菌	6	28.57	12	7.41	25	5.63	80	4.56	123	5.16	26.672	<0.001
嗜肺军团菌	1	4.76	0	0	3	0.68	18	1.03	22	0.92	4.610	0.178
结核分枝杆菌	0	0	9	5.56	27	6.08	39	2.22	75	3.15	21.220	<0.001
肺炎支原体	0	0	5	3.09	2	0.45	11	0.63	18	0.76	8.802	0.033
肺炎衣原体	0	0	0	0	0	0	18	1.03	18	0.76	6.286	0.086
合计	12	57.14	84	51.85	165	37.16	975	55.56	1 236	51.89	48.256	<0.001

病原菌	<20岁（21例）		20~39岁（162例）		40~59岁（444例）		≥60岁（1 755例）		合计		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
肺炎链球菌	1	4.76	11	6.79	9	2.03	54	3.08	75	3.15	9.085	0.028
金黄色葡萄球菌	4	19.05	6	3.70	18	4.05	126	7.18	154	6.47	13.290	0.004
耐甲氧西林金黄色葡萄球菌	6	28.57	18	11.11	51	11.49	336	19.15	411	17.25	20.907	<0.001
大肠埃希菌	0	0	0	0	21	4.73	66	3.76	87	3.65	8.460	0.037
肺炎克雷伯菌	3	14.29	3	1.85	40	9.01	287	16.35	333	13.98	37.161	<0.001
铜绿假单胞菌	3	14.29	6	3.70	39	8.78	195	11.11	243	10.20	10.408	0.015
鲍曼不动杆菌	2	9.52	12	7.41	63	14.19	384	21.88	462	19.40	30.879	<0.001
嗜麦芽窄食单胞菌	3	14.29	0	0	12	2.70	119	6.78	134	5.63	24.178	<0.001
流感嗜血杆菌	6	28.57	12	7.41	25	5.63	80	4.56	123	5.16	26.672	<0.001
嗜肺军团菌	1	4.76	0	0	3	0.68	18	1.03	22	0.92	4.610	0.178
结核分枝杆菌	0	0	9	5.56	27	6.08	39	2.22	75	3.15	21.220	<0.001
肺炎支原体	0	0	5	3.09	2	0.45	11	0.63	18	0.76	8.802	0.033
肺炎衣原体	0	0	0	0	0	0	18	1.03	18	0.76	6.286	0.086
合计	12	57.14	84	51.85	165	37.16	975	55.56	1 236	51.89	48.256	<0.001

病原菌	春季（819例）		夏季（333例）		秋季（405例）		冬季（825例）		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
肺炎链球菌	30	3.66	3	0.90	27	6.67	15	1.82	27.454	<0.001
金黄色葡萄球菌	69	8.42	19	5.71	24	5.93	42	5.09	8.290	0.040
耐甲氧西林金黄色葡萄球菌	126	15.38	63	18.92	92	22.72	130	15.76	12.408	0.006
大肠埃希菌	12	1.47	26	7.81	15	3.70	34	4.12	27.992	<0.001
肺炎克雷伯菌	110	13.43	37	11.11	63	15.56	123	14.91	3.913	0.271
铜绿假单胞菌	48	5.86	28	8.41	75	18.52	92	11.15	49.408	<0.001
鲍曼不动杆菌	165	20.15	59	17.72	88	21.73	150	18.18	3.082	0.379
嗜麦芽窄食单胞菌	66	8.06	20	6.01	27	6.67	21	2.55	24.792	<0.001
流感嗜血杆菌	44	5.37	15	4.50	15	3.70	49	5.94	3.145	0.370
病原菌	春季（819例）		夏季（333例）		秋季（405例）		冬季（825例）		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
嗜肺军团菌	7	0.85	3	0.90	12	2.96	0	0	24.254	<0.001
结核分枝杆菌	37	4.52	5	1.50	18	4.44	15	1.82	15.015	0.002
肺炎支原体	12	1.47	0	0	0	0	6	0.73	10.463	0.009
肺炎衣原体	15	1.83	0	0	0	0	3	0.36	16.823	<0.001
合计	441	53.85	138	41.44	243	60.00	414	50.18	27.453	<0.001

病原菌	春季（819例）		夏季（333例）		秋季（405例）		冬季（825例）		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
肺炎链球菌	30	3.66	3	0.90	27	6.67	15	1.82	27.454	<0.001
金黄色葡萄球菌	69	8.42	19	5.71	24	5.93	42	5.09	8.290	0.040
耐甲氧西林金黄色葡萄球菌	126	15.38	63	18.92	92	22.72	130	15.76	12.408	0.006
大肠埃希菌	12	1.47	26	7.81	15	3.70	34	4.12	27.992	<0.001
肺炎克雷伯菌	110	13.43	37	11.11	63	15.56	123	14.91	3.913	0.271
铜绿假单胞菌	48	5.86	28	8.41	75	18.52	92	11.15	49.408	<0.001
鲍曼不动杆菌	165	20.15	59	17.72	88	21.73	150	18.18	3.082	0.379
嗜麦芽窄食单胞菌	66	8.06	20	6.01	27	6.67	21	2.55	24.792	<0.001
流感嗜血杆菌	44	5.37	15	4.50	15	3.70	49	5.94	3.145	0.370
病原菌	春季（819例）		夏季（333例）		秋季（405例）		冬季（825例）		χ²值	P值
病原菌	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	阳性例数	阳性率/ %	χ²值	P值
嗜肺军团菌	7	0.85	3	0.90	12	2.96	0	0	24.254	<0.001
结核分枝杆菌	37	4.52	5	1.50	18	4.44	15	1.82	15.015	0.002
肺炎支原体	12	1.47	0	0	0	0	6	0.73	10.463	0.009
肺炎衣原体	15	1.83	0	0	0	0	3	0.36	16.823	<0.001
合计	441	53.85	138	41.44	243	60.00	414	50.18	27.453	<0.001

病原菌	男性		女性		χ²值	P值
病原菌	阳性例数	阳性率/%	阳性例数	阳性率/%	χ²值	P值
肺炎链球菌	62	3.94	13	1.61	9.464	0.002
金黄色葡萄球菌	103	6.54	51	6.32	0.043	0.836
耐甲氧西林金黄色葡萄球菌	320	20.32	91	11.28	30.550	<0.001
大肠埃希菌	75	4.76	12	1.49	16.263	<0.001
肺炎克雷伯菌	248	15.75	85	10.53	12.059	0.001
铜绿假单胞菌	156	9.90	87	10.78	0.447	0.504
鲍曼不动杆菌	324	20.57	138	17.10	4.112	0.043
嗜麦芽窄食单胞菌	94	5.97	40	4.96	1.029	0.310
流感嗜血杆菌	88	5.59	35	4.34	1.703	0.192
嗜肺军团菌	9	0.57	13	1.61	6.301	0.012
结核分枝杆菌	51	3.24	24	2.97	0.122	0.727
肺炎支原体	12	0.76	6	0.74	0.002	0.961
肺炎衣原体	9	0.57	9	1.12	2.104	0.147
合计	866	54.98	370	45.85	17.838	<0.001