艾滋病患者感染菌群分布及耐药性分析

目的分析医院艾滋病患者感染病原菌的分布及耐药性,以指导临床医师合理用药。方法对医院2009年8月-2010年9月收治的艾滋病患者各类标本分离所得418株病原菌,采用自动微生物分析仪及配套试剂进行细菌鉴定与药敏试验。结果在418株分离的病原菌中,真菌感染占48.6%,革兰阴性杆菌占30.6%,革兰阳性菌占20.8%,病原菌以大肠埃希菌、新型隐球酵母菌、白色假丝酵母菌、马内菲青霉菌、肺炎克雷伯菌、肺炎链球菌、人葡萄球菌为主,同时,新型隐球酵母菌呈上升趋势,罕见马红球菌种日渐体现;两性霉素B及5-氟胞嘧啶对新型隐球酵母菌、白色假丝酵母菌敏感,伊曲康唑对马内菲青霉菌敏感,亚胺培南对各种肠杆菌科细菌有较强抗菌活性,大肠埃希菌对第二、三代头孢菌素敏感率仅为20.0%～35.0%;对头孢噻肟、左氧氟沙星、头孢唑林、磺胺甲噁唑/甲氧苄啶及氨苄西林高度耐药,肺炎链球菌对克林霉素、苯唑西林、红霉素及磺胺甲噁唑/甲氧苄啶耐用率高达80.0%～86.0%。结论艾滋病患者感染病原菌分布较复杂,病原菌的耐药形势严峻,加强耐药性连续监测,对临床合理使用抗菌药物、减少耐药菌产生有特别意义。

Distribution of pathogens causing infections in AIDS patients and analysis of drug resistance

OBJECTIVE To analyze the pathogenic distribution and their resistance and to provide the evidence for the clinical use of drug.METHODS A total of 418 strains of pathogens were isolated from various samples of AIDS patients from Aug 2009 to Sep 2010,the species were identified by Automatic Analyzer for Microbes,and the drug susceptibility testing was performed.RESULTS Of 418 strains of pathogens isolated,fungi,gram-negative bacilli and gram-positive bacteria accounted for 48.6%,30.6%,and 20.8%,respectively.The most common pathogens were Escherichia coli,Cryptococcus neoformans,Candida albicans,Penicillium marneffei,Klebsiella pneumoniae,Streptococcus pneumoniae and Staphylococcus hominis;C.neoformans kept an increasing tendency,and the rare Rhodococcus equi were found.C.neoformans and C.albicans were susceptible to amphotericin B and 5-Fluorocytosine.P.marneffei was susceptible to itraconazole,imipenem had strong antibacterial activity to various Enterobacteriaceae species,the susceptibility rates of E.coli to the second generation and third generation of cephalosporins varied from 20.0% to 35.0%,but E.coli isolates were highly resistant to cefotaxime,levofloxacin,cefazolin,sulfamethoxazole/trimethoprim,and ampicillin.The resistance rates of S.pneumoniae to clindamycin,oxacillin,erythromycin,and sulfamethoxazole/trimethoprim varied from 80.0% to 86.0%.CONCLUSION The pathogens causing infections in the AIDS patients are special and highly resistant to antibiotics,so it is necessary to intensify continuous surveillance for drug resistance.