肺结核合并肺部感染患者的病原菌耐药性分析

目的 探讨肺结核合并肺部感染患者的病原菌分布及耐药性,为临床合理用药提供参考.方法 对2013年7月至2015年6月我院收治的肺结核合并肺部感染的181例患者采集痰液标本,分离培养病原菌进行药敏试验并分析.结果 181例患者的所有合格痰液标本中共分离出病原菌214株,其中136株为革兰阴性菌株占63.55％,革兰阳性菌株56株(26.17％),真菌22株(10.28％);药敏试验结果显示,主要革兰阴性菌对头孢唑林、氨苄西林、哌拉西林、头孢曲松、氨曲南等具有较强的耐药性(均＞50％),对亚胺培南及阿米卡星敏感;主要革兰阳性菌对红霉素、青霉素、头孢唑林及阿奇霉素等抗菌药有较强的耐药性(均＞50％),对万古霉素敏感;主要真菌对酮康唑、氟康唑及伏立康唑等有较强耐药性,对两性霉素敏感.结论 肺结核患者发生肺部感染情况较复杂,感染的细菌菌株不同,对多种抗菌药耐药率较高,应加强耐药性监测工作,减少不合理用药,避免增加致病菌耐药概率,使肺结核患者得到积极有效的治疗.

Drug resistance of pathogens causing pulmonary infections in pulmonary tuberculosis patients

Objective To investigate the distribution and drug resistance of pathogenic bacterial isolated from pulmonary tuberculosis patients complicated with pulmonary infection and to guide rational usage of antibiotics.Methods The sputum specimens were collected from 181 pulmonary tuberculosis patients complicated with pulmonary infection who were treated in the hospital from Jul 2013 to Jun 2015,and the drug susceptibility testing was performed for the isolated pathogens to analyze the drug resistance.Results A total of 214 strains of pathogens had been isolated from the sputum specimens obtained from the 181 patients,including 136 (63.55 ％) strains of gram-negative bacteria,56 (26.17％)strains of gram-positive bacteria,and 22 (10.28％) strains of fungi.The gram-negative bacteria were highly resistant to ampicillin,cefazolin,piperacillin,aztreonam,ceftriaxone.The gram-negative bacteria were highly sensitive to imipenem and amikacin.The gram-positive cocci were highly resistant to penicillin,erythromycin,azithromycin,cefazolin,and the strains were susceptible to vancomycin.The fungi were highly resistant to ketoconazole,fluconazole,voriconazole,and were susceptible to amphotericin.Conclusions Infection in patients with tuberculosis are complex,and with infection of different bacterial strains,different sensitivity to antimicrobial drugs,a timely manner with sputum culture is recommended,combined with the results of drug susceptibility testing rational selection of antibiotics,avoiding unjustified medication,increased resistance to pathogens medicine chance.