肺结核患者合并下呼吸道感染病原菌的特征及药敏分析

目的通过对178例合并下呼吸道感染的肺结核患者的菌种分布及药敏结果分析,以期了解本院感染的流行趋势及耐药特征。方法对大连市结核病医院178例已确诊的肺结核合并下呼吸道感染的名患者共193株病原菌培养及药敏结果进行回顾性统计分析。结果 193株病原菌中革兰氏阳性球菌(G+)15株,占7.77%,其中金黄色葡萄球菌11株(5.70%),表皮葡萄球菌3株(1.55%),腐生葡萄球菌1株(0.52%),对万古霉素高度敏感;革兰氏阴性杆菌(G-)82株,占42.49%,其中肺炎克雷伯菌肺炎亚种48株(24.87%),大肠埃希菌12株(6.22%),阴沟肠杆菌7株(3.63%),铜绿假单胞菌5株(2.59%),其它共计10株(5.18%),对亚胺培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、喹诺酮类药物敏感性较高;真菌96株,均为白假丝酵母菌,占49.74%,对所有真菌药物均敏感。结论我院合并下呼吸道感染的肺结核患者以真菌和革兰阴性杆菌感染为主,在未获得细菌培养和药敏结果前,可根据本院感染的流行趋势以及病原学特点选用抗菌药物进行治疗,以争取最佳的治疗时机,从而获得良好的初始治疗效果。

Analysis of pathogenic bacteria and drug sensitivity of pulmonary tuberculosis patients with lower respiratory tract infection

Objective To understand the trends and antimicrobial characteristics of pulmonary tuberculosis patients with lower respiratory tract infection. Methods 193 strains of pathogenic bacteria and its results of drug sensitivity test of 178 pulmonary tuberculosis patients with lower respiratory tract infection were retrospectively analyzed. Results There were 15 strains of Gram-positive Cocci （G＋） （7.77%）, which included 11 strains of Staphylococcus Aureus （5.70%）, 3 strains of Staphylococcus Epidermidis （1.55%）, and 1 strain of Staphylococcus Saprophyticus （0.52%） and were highly sensitive to vancomycin. There were 82 strains of Gram-negative Bacilli （G-） （42.49%）, which included 48 strains of Klebsiella pneumoniae subspecies （24.87%）, 12 strains of Escherichia Coli （6.22%）, 7 strains of Enterobacter Cloacae （3.63%）, 5 strains of Pseudomonas Aeruginosa （2.59%）, and 10 another strains （5.18%）. They were highly sensitivity to imipenem, amikacin, cefoperazone/sulbactam, piperacillin/tazobactam, and quinolones. There were 96 strains of fungus, all of which were Candida Albicans, accounting for 49.74%. They showed sensitivity to all fungal drugs. Conclusion The main pathogenic bacteria of pulmonary tuberculosis patients with lower respiratory tract infection in our hospital are Gram-negative bacteria and fungus. Without the prior bacterial culture and sensitivity test results, they can be given timely treatment based on our hospital infection trends and etiological characteristics to obtain good initial therapeutic effect.