非结核分枝杆菌肺病20例临床分析

目的 探讨非结核分枝杆菌肺病的临床特点.方法 2001年3月～2009年12月间,在我院门诊20例痰培养为非结核分枝杆菌肺病的患者进行耐药试验,对其临床表现及治疗效果进行分析总结.结果 非结核分枝杆菌肺病多被误诊为肺结核,一线抗结核药物均不同程度耐药,根据耐药试验结果选择有效药物进行治疗可取得较好的临床治疗效果.结论 尽早对疑似病人进行痰分枝杆菌培养及鉴定,耐药试验监测,可降低非结核分枝杆菌肺病的误诊率,提高治疗效果.     

非结核分枝杆菌肺病患者非结核分枝杆菌和下呼吸道病原菌分布及耐药性分析

目的分析非结核分枝杆菌肺病患者非结核分枝杆菌和下呼吸道病原菌分布及耐药性。方法选取2014—2016年徐州医科大学附属徐州市传染病医院收治的非结核分枝杆菌肺病患者152例,采集其痰液标本进行培养、菌种鉴定及药敏试验。结果 (1)152例非结核分枝杆菌肺病患者共检出非结核分枝杆菌152株,分离鉴定出7个非结核分枝杆菌菌种,包括快速生长群64株(占42.11%),其中以龟/脓肿分枝杆菌(占78.13%)为主;缓慢生长群88株(占57.89%),其中以鸟分枝杆菌复合群(68.18%)为主。药敏试验结果显示,龟/脓肿分枝杆菌对链霉素、异烟肼、利福平的耐药率均为100.00%,鸟分枝杆菌复合群对链霉素、异烟肼、对氨基水杨酸、氧氟沙星的耐药率均为100.00%。(2)152例非结核分枝杆菌肺病患者下呼吸道样本共分离出病原菌88株,包括革兰阴性菌53株(占60.23%),真菌32株(占36.36%),革兰阳性菌3株(占3.41%)。革兰阴性菌以肺炎克雷伯菌(占22.64%)为主,真菌以白色假丝酵母菌(占84.37%)为主,革兰阳性菌均为金黄色葡萄球菌(占100.00%)。药敏试验结果显示,肺炎克雷伯菌对氨苄西林的耐药率为100.00%,对呋喃妥因的耐药率为83.33%,对其他常见抗菌药物敏感性较高。结论非结核分枝杆菌肺病患者非结核分枝杆菌以缓慢生长群为主,且对大部分常见抗菌药物耐药;下呼吸道病原菌以革兰阴性菌为主,且对大部分常见抗菌药物敏感;临床应根据药敏试验结果合理选择抗菌药物。     

非结核分枝杆菌病50例临床分析

目的探讨非结核分枝杆菌病的临床特点和提高非结核分枝杆菌病的诊断和治疗水平。方法1999年8月～2006年3月间在北京胸科医院住院治疗的患者,痰培养分枝杆菌阳性、菌种鉴定为非结核分枝杆菌的50例患者,进行耐药试验并对其临床表现及治疗效果进行总结。结果非结核分枝杆菌肺病患者对一线抗结核药物均有不同程度的耐药,其中对异烟肼（H）、链霉素（s）耐药率最高,对丁胺卡那霉素（Am）、卡那霉素（Kin）耐药率较低。结论非结核分枝杆菌肺病确诊靠菌种鉴定,早期给予合理的化疗方案可取得一定的效果。     

40株非结核分枝杆菌菌种鉴定及其耐药情况分析

目的：对40株非结核分枝杆菌（ NTM）进行菌种鉴定,并观察其耐药情况。方法收集来源于肺结核患者痰标本的40株NTM,经Bactec MGIT960系统培养,应用基因芯片分型,采用绝对浓度法对其进行10种抗结核药物敏感性测试。结果40株NTM中,胞内分枝杆菌20株,龟分枝杆菌9株,堪萨斯分枝杆菌4株,戈登分枝杆菌3株,偶然分枝杆菌2株,浅黄分枝杆菌、土分枝杆菌各1株;其中,同时合并结核分枝杆菌复合群感染者3例,分别为龟分支杆菌2例、土分枝杆菌1例。 NTM对抗结核药物的总体耐药率100％。其中对10种所测试药物全部耐药9株,以龟分枝杆菌为主（占77．8％）;NTM对乙胺丁醇的敏感率为62．5％,高于其他药物（P均＜0．05）。结论40株NTM中胞内分枝杆菌比例最高,其次为龟分枝杆菌、堪萨斯和戈登分枝杆菌;NTM耐药情况严重,对乙胺丁醇敏感性较高。     

非结核分枝杆菌病50例临床分析

目的探讨非结核分枝杆菌病的临床特点和提高非结核分枝杆菌病的诊断和治疗水平。方法1999年8月—2006年3月间在北京胸科医院住院治疗的患者,痰培养分枝杆菌阳性、菌种鉴定为非结核分枝杆菌的50例患者,进行耐药试验并对其临床表现及治疗效果进行总结。结果非结核分枝杆菌肺病患者对一线抗结核药物均有不同程度的耐药,其中对异烟肼(H)、链霉素(S)耐药率最高,对丁胺卡那霉素(Am)、卡那霉素(Km)耐药率较低。结论非结核分枝杆菌肺病确诊靠菌种鉴定,早期给予合理的化疗方案可取得一定的效果。     

23株非结核分枝杆菌药物敏感性试验分析

目的 对自贡市临床分离鉴定的23株非结核分枝杆菌分别进行26种抗生素的药物敏感试验,了解非结核分枝杆菌对不同抗生素的耐药性,为非结核分枝杆菌病临床治疗提供依据。方法 采用微孔板阿尔玛蓝测定法(microplate Alamarblue assay,MABA)测试每种药物对每株非结核分枝杆菌的最低抑菌浓度(MIC值),通过MIC值判断该菌对此种抗生素是否耐药。结果 非结核分枝杆菌对大部分抗结核药物耐药,并且对部分药物的耐药存在种间差异。其中脓肿分枝杆菌耐药率达84.6%,鸟分枝杆菌与胞内分枝杆菌分别达53.8%与52.3%,堪萨斯分枝杆菌耐药率最低为38%。结论 对临床非结核分枝杆菌肺病,快速菌株鉴定及药敏试验是治疗的关键。     

漳州市复治耐药肺结核的临床和病原学分析

目的了解漳州市复治耐药肺结核的临床特征和病原学情况。方法经对复治肺结核患者的晨痰、胸液进行分枝杆菌培养、鉴定和抗结核药物敏感性试验。结果11例复治肺结核患者中,2例规则抗结核治疗,9例抗结核药物未满疗程。均为继发性肺结核,8例为结核分枝杆菌感染,1例“复治肺结核”为非结核分枝杆菌病。8例复治培阳肺结核患者均有不同程度耐药。耐多药5例,耐药种类3—10种。所有耐药菌株中发现2株为利福平依赖菌。结论复治肺结核多表现有空洞、肺毁损,易继发感染、合并糖尿病、肺心病。不规则用药是导致复治和耐药的最常见原因。耐药率为72．7％,肺结核耐多药率达62．5％。对漳州复治肺结核患者有必要广泛开展结核分枝杆菌培养、鉴定和药物敏感性试验,更利于医疗、防疫人员循证科学施治,对预防耐药肺结核发生和减少耐药肺结核的社区传播具有重要意义。     

社区获得性快生长型非结核分支杆菌肺病58例临床分析

目的 了解社区获得性快生长型非结核分枝杆菌肺病的临床特点?方法 对 1.986年 1月至1.997年 1.2月间痰抗酸杆菌培养阳性 3.907例中 ,经菌型鉴定证明为快生长型非结核分枝杆菌肺病 58例进行回顾性分析?结果 按Runyon分类法 ,感染Ⅳ型偶然分枝杆菌 3.8例 ,龟分枝杆菌 2.0例?男 3 9例 ,女 1.7例 ,病程 8～ 4.0年?主要症状为咳嗽?咳白粘痰?咯血?发热?X线胸片两侧受累者 60 3 % ,左侧 2.41 % ,右侧 1 5.5%?对异烟肼?链霉素?乙胺丁醇?利福平?对氨基水杨酸?丙硫异烟胺耐药率很高 ,对卡那霉素耐药率相对较低?结论 快生长型非结核分枝杆菌肺病病程长 ,症状不特异 ,耐药率高 ,抗结核治疗疗效差?     

耐药肺结核病人治疗现况研究

目的 探讨初始耐药与获得性耐药肺结核病人的情况与治疗效果，对初始与获得性耐药肺结核病人的管理与治疗提供参考依据。方法 肺结核患者的痰标本用L-J培养基进行结核分枝杆菌分离培养，对全部阳性菌株用PNB进行人型与牛型、结核与非结核分枝杆菌的菌种的鉴定。采用比例法检测分离的结核分枝杆菌菌株对抗结核药物的敏感性。分析完成规定疗程的耐药肺结核病人225例的耐药与治疗情况。结果 初始耐药肺结核病人149例，其中耐单药87例，耐多药62例；耐单药者中耐SM占41．38％，耐INH占39．08％，耐RFP占13．79％，耐EMB占5．79％；初始耐药病人耐多药者中耐HR占37．1％，耐HRES占29．0％，耐HRS占21．0％，耐HRE占12．9％。获得性耐药肺结核病人76例，其中耐单药者38人，耐SM占39．48％，耐INH占34．21％，耐RFP占21．05％，耐EMB占5．26％；获得性耐多药38例，耐HR占52．6％；耐HRES占21．1％，耐HRS占。18．4％，耐HRE7．9％。初始耐单药肺结核病人治愈率94．25％；耐多药肺结核病人治愈率88．7％；获得性耐单药肺结核病人治愈率92．1％，耐多药肺结核病人治愈率63．2％。结论 初始与获得性耐药肺结核病人的耐单药发生率排序一致，依次为SM、INH、RFP及EMB。初治与获得性耐多药肺结核病人的耐多药排序亦相同，依次为HR、HRES、HRS及HRE。研究结果提示，对耐单药的肺结核病人应用现有的短程化疗方案，仍可获得较好的治疗效果，而耐多药肺结核病人应用现有的短程化疗方案的治疗效果则较差。控制耐药的关键是积极治疗传染性耐药结核病患者，降低原发耐药率与继发耐药率。     

44例痰非结核分枝杆菌耐药情况分析

目的观察分析痰非结核分枝杆菌（NTM）的耐药情况。方法回顾近年太原市第四人民医院痰分枝杆菌培养阳性并鉴定为非结核分枝杆菌的病例,对其药敏结果进行分析。结果 437例痰分枝杆菌培养阳性病例中,44株为非结核分枝杆菌,占10.07%,44株非结核分枝杆菌对异烟肼、对氨基水杨酸钠、乙胺丁醇、利福平、链霉素等常用药物有不同程度的耐药,耐药率高达97.7%,且大都同时对多种药物耐药。结论非结核分枝杆菌对抗结核药的高耐药应引起重视,应对可疑NTM肺病及早做痰培养和尽可能多的药物敏感性测定,研究抗NTM新药与更有效的诊治手段是当前的迫切需要。     

The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance]

The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.     

Treatment for multidrug-resistant tuberculosis in Japan

INTRODUCTION: Multidrug-resistant (MDR) tuberculosis is now refractory against standard chemotherapy for tuberculosis. The curability of medical treatments for it has been up to 50-75%. In Japan several hundreds new MDR tuberculosis cases are supposed to occur every year. This review is the outline of Japanese preliminary guideline of treatment for MDR tuberculosis. DRUG SUSCEPTIBILITY TEST: One of the most important points to manage MDR tuberculosis is the drug usages according to drug susceptibility. Recently some susceptibility tests with liquid media were introduced in our country, but Japanese new standard test of Ogawa method (using absolute concentration with proportion method) is still important from point of true evaluation of susceptibility. MEDICAL CHEMOTHERAPY: In MDR tuberculosis one-half of two-third cases are cured by suitable resume of anti-tuberculosis chemotherapy. If patients would prove to be suffered from MDR tuberculosis, chemotherapy resume must be changed from standard resume to special one, that are made from effective and stronger four or five (at least three) anti-tuberculosis drugs including new quinolons. Those drugs should be changed at the same time, not one by one. Although CPM and Tb1 cannot be available in Japan, but sometimes we have to try administrations of those drugs, beta-lactam antibiotics, interferon. The duration of treatment will be 18-24 months usually. If decreasing of tuberculosis bacilli in sputa is failed under new effective resume through four months treatment, surgical treatment may be indicated. SURGICAL TREATMENT: (1) In Fukujuji Hospital, Japan Anti-Tuberculosis Association, surgical treatments for seventy four cases of MDR tuberculosis were undergone from 1983 to 2001 March. 85 surgical interventions for them were performed in 71 pulmonary resections (pneumonectomy in 20, lobectomy in 44, segmentectomy in 7) for 64 cases, 8 thoracoplasties alone for 8 cases, 5 cavernostomies for 5 cases, 1 phrenic nerve avulsion for 1. The result of pulmonary resections was as follows; early negative conversion rate of tuberculosis expectorations was 97.2%, reexpectoration rate of sputa tuberculosis bacilli was 13.8%, final success rate of pulmonary resections was 91.7%. The factors significantly correlated to reexpectoration of tuberculosis bacilli were preoperative positive bacilli in sputa, few sensitive drugs, other cavitary lesions remained, postoperative prolonged bronchopleural fistula. The result of thoracoplasty alone revealed 75% success rate. In postoperative complications of 85 interventions, there was no operative death, prolonged bronchopleural fistula in 17.6%, respiratory failure in 8.7%, pyothorax in 5.9%. (2) Recently results of surgical treatment for MDR tuberculosis were reported in several literatures. Those success rates were almost same 85-95% as our result. They seemed to be very excellent for refractory cases against vigorous medical treatments. So any surgical treatment for MDR tuberculosis should be indicated more constructively in its earlier course. (3) Indication of surgical treatment is as follows; Main target lesions that should be removed are cavitary ones in pulmonary or pleural foci. And any capsulated localized tuberculosis foci more than 2 cm in diameter is better to be resected because of the possibility of later cavitation. Surgically it is the best that all tuberculosis foci are within a resected lobe, effective drugs remained as many as possible and no cardiopulmonary risks. But even if patient's state are over those criteria, resections of more extended pulmonary foci including in opposite sides can be tried within tolerable cardiopulmonary function. OTHER COMMENTS: Treatment for HIV-positive MDR tuberculosis and protection for nosocomial transmission of MDR tuberculosis are discussed briefly in this article. Preventive therapy for newly infected persons with MDR tuberculosis is controversial. At this time just in MDR tuberculosis cases no preventive therapy, careful following up, and drastic treatment with remained effective drugs after developping of disease will be recommended.     

住院肺结核病人对氧氟沙星耐药的分析

目的探讨住院肺结核病人对氧氟沙星的耐药性?方法就1993年1月~1995年12月我院住院肺结核病人痰结核菌培养阳性并有药敏结果者205例进行了对氧氟沙星耐药性的回顾性调查?结果继发耐药者11例(17.5%),原发耐药者2例(1.4%),通过对氧氟沙星耐药病例的分析,考虑用药时间长及相当于单一用药是氧氟沙星继发耐药产生的原因;而原发耐药的产生,可能与感染耐药菌有关?此外,对氧氟沙星耐药者的疗效明显不及敏感者?结论目前氧氟沙星耐药率较低,故氧氟沙星不失为临床上一个新的?有效的抗结核药?     

非免疫缺陷患者肺隐球菌病的临床特征及疗效分析

目的 分析非免疫缺陷患者肺隐球菌病的临床特征及疗效.方法 回顾性分析陆军特色医学中心2017年1月至2020年6月确诊肺隐球菌病患者的病历资料39例,人口学资料,基础疾病,临床表现,影像学特征,病理检查结果,治疗方案和临床结局.收集患者肺组织病理学检测结果和痰液样本,分析是否存在隐球菌感染,对部分患者进行了隐球菌抗原检...     

156例肺结核患者下呼吸道致病菌种鉴定及临床分析

目的 探讨肺结核患者下呼吸道致病菌种分布特点?细菌耐药情况及并发肺感染时临床特征?方法 选156 例痰普通菌或真菌培养发现致病菌株的肺结核患者,确定菌种后进行抗菌药物体外药敏检测?结果 156 例患者痰细菌培养发现致病菌株239 例次?其中革兰氏阴性杆菌210 株(87.9 % ) ,真菌21 株(8.8 % ) ,革兰氏阳性球菌8 株(3.3 % ) ?药物敏感检测环丙沙星敏感菌株最高为60.6 % ,利福平最低为4.1 % ?结论 肺结核患者呼吸道致病菌种以革兰氏阴性杆菌居多,可能与患者免疫功能低下?滥用抗生素及抗结核药物有关?     

40例堪萨斯分枝杆菌肺病的临床特征及药敏特点分析

目的分析堪萨斯分枝杆菌肺病的临床特征及药敏特点。方法回顾分析2016年1月至2021年2月期间本院确诊的非结核分枝杆菌(NTM)肺病患者的临床资料;将NTM肺病分为堪萨斯分枝杆菌肺病组和非堪萨斯NTM肺病组,对两组的临床特征进行比较。结果164例NTM肺病的菌种分布为胞内分枝杆菌(64.0%)、堪萨斯分枝杆菌(24.4%)、其它少见NTM(11.6%)。堪萨斯分枝杆菌肺病高发年龄为20~49岁,男性多见,主要症状为咳嗽咳痰、咯血、胸痛、胸闷、发热。堪萨斯分枝杆菌肺病病灶多累及单叶、上叶;主要表现为空洞、结节、索条影、斑片及实变等;空洞以薄壁空洞为主。堪萨斯组IGRAs的阳性率为55.0%,明显高于非堪萨斯组的11.3%(P<0.01)。堪萨斯分枝杆菌对常用的抗分枝杆菌药物的耐药率分别为利福平5.0%、异烟肼82.5%、乙胺丁醇30.0%、阿米卡星42.5%、氧氟沙星22.5%。结论堪萨斯分枝杆菌为NTM肺病的常见分离菌株之一。堪萨斯分枝杆菌肺病多见于中青年男性;肺部病灶上叶多见,形态多样,空洞常见;利福平耐药率较低,异烟肼耐药率较高。     

河南省安阳市耐药肺结核病人治疗转归分析

目的为了解安阳市耐药肺结核病人治疗转归现况,为今后耐药病人的管理与治疗提供参考依据。方法将安阳市结核病防治所1994年6月至2004年6月10年间登记的耐药肺结核病人病历资料收集统计,进行回顾性总结分析。结果10年登记耐药肺结核病人221例,其中,初始耐药115例,获得性耐药106例;耐1药87例,耐2药57例,耐3药以上77例;MDR-PTB 60例;全程管理177例,自服药44例;标化治疗122例,个体化治疗99例;规则服药完成疗程165例,丢失56例。221例耐药肺结核病人1年转归总治愈率52.5%,丢失率25.3%。初始耐药病人治愈率67.0%,其中标化治疗耐1药病人治愈率88.1%;获得性耐药病人治愈率36.8%,其中标化治疗耐1药病人治愈率37.5%;MDR-PTB病人治愈率30.0%;规则服药完成疗程病人治愈率70.3%。结论短程标准化疗方案治疗初始耐药病人,特别是耐1药病人有较高的疗效,治疗获得性耐药病人及MDR病人效果较差。丢失率偏高是影响疗效的重要因素。建议对耐药病人实行专项登记,专项考核,强化管理措施,努力降低丢失率,减少难治性肺结核的发生。     

肺结核并发真菌感染危险因素及药物敏感性情况分析

目的探讨肺结核并发真菌感染的危险因素及药物敏感性(药敏)情况,为该病的预防、诊断和治疗提供依据。方法选取2011年5月—2012年5月在本院住院治疗的肺结核患者179例,按真菌感染情况分为非真菌感染组(108例)和真菌感染组(71例)。分析2组的临床特点,采用酵母菌显色培养基判断菌种,应用ROSCO纸片扩散法进行药敏分析。结果肺结核并发真菌感染的危险因素为继发性肺结核、复治、痰涂片抗酸染色阴性、长期使用糖皮质激素和广谱抗生素以及合并基础疾病(OR均≥2)。导致肺部真菌感染的主要真菌为假丝酵母菌(87.32%),其中白色假丝酵母菌耐药率低,只有7株对5-氟胞嘧啶耐药;10株热带假丝酵母菌中各有2株对益康唑和两性霉素B耐药;光滑假丝酵母菌只对伊曲康唑敏感。结论①对继发性肺结核、复治、长期使用糖皮质激素和广谱抗生素以及合并基础疾病的肺结核患者要注意肺部真菌感染的预防治疗;②痰涂片抗酸染色阴性可作为早期诊断敏感指标;③对已感染真菌的肺结核患者要行药敏试验,选取最佳抗真菌药物,对光滑假丝酵母菌感染者应提高警惕。     

A retrospective study for the outcome of pulmonary resection in 49 patients with multidrug-resistant tuberculosis.

BACKGROUND: Outcome of treatment using only chemotherapy for multidrug-resistant tuberculosis is usually considered not to be satisfactory. The combination of chemotherapy with surgical treatment has been producing higher acid-fast bacilli (AFB) negative sputum conversion and longer survival rates. This treatment strategy may be the solution for patients with multidrug-resistant tuberculosis. MATERIALS AND METHODS: A retrospective review was performed of the medical records and laboratory findings of 49 patients with multidrug-resistant tuberculosis among 130 patients who underwent pulmonary resection for pulmonary tuberculosis between January 1995 and December 1999 at National Masan Tuberculosis Hospital, Korea. RESULTS: The mean number of drugs to which the patients were resistant was 4.5. Patients had a mean age of 35 years. Cavitary lesions on plain chest X-ray were shown in 43/49 patients (87.8%); 31 had positive sputum cultures preoperatively (63.3%). The surgical techniques used were as follows: 12 pneumonectomies, 28 lobectomies, seven lobectomies with segmentectomies or wedge resections, one wedge resection and one cavernoplasty. The AFB negative sputum conversion rate was 93.5% with continuous postoperative chemotherapy. There were no deaths after surgery. Postoperative complications that developed were six cases of air leakage over a week, one of postoperative bleeding and one of wound infection. CONCLUSIONS: This study demonstrated the effectiveness of pulmonary resection with postoperative chemotherapy in cases of multidrug-resistant tuberculosis. Although there are different ideas about indications for surgery and the length and content of postoperative drug regimens, pulmonary resection should be considered an effective measure in combination with chemotherapy for treatment of multidrug-resistant pulmonary tuberculosis.