结核患者下呼吸道感染菌群分布及药敏分析

目的探讨肺结核并发下呼吸道感染者病原菌分布特点及耐药性，分析肺结核并发下呼吸道感染的危险因素。方法2011年1月至2013年12月对住院肺结核患者进行细菌分离及药敏试验，分析影响患者下呼吸道感染的危险因素。结果485例肺结核住院患者中并发下呼吸道感染125例（25．77％），共分离病原菌425株，其中革兰阳性球菌165株（38．82％），革兰阴性杆菌228株（53．65％），真菌32株（7．53％）。革兰阳性菌对利奈唑胺敏感性较高，铜绿假单胞菌对氨曲南、头孢他啶及头孢吡肟敏感，肺炎克雷伯菌对头孢吡肟敏感，大肠埃希菌对亚胺培南、派拉西林及环丙沙星敏感性高，鲍曼不动杆菌对常规抗菌药物均表现为耐药。年龄、病程、病灶、抗菌药物应用种类及住院时间是影响肺结核并发下呼吸道感染的危险因素。结论肺结核并发呼吸道感染者细菌耐药性较高，临床应加强对高龄、病程长、病灶多、住院时间长等高危患者的管理，合理应用抗菌药物，加强对患者耐药性观察，可有效降低肺结核并发下呼吸道感染的发病率。

The flora distribution and drug sensitivity of tuberculosis in patients with lower respiratory tract infections

Objective To investigate the flora distribution and drug sensitivity of tuberculosis in patients with lower respiratory tract infections and analyze the risk factors of tuberculosis in patients with lower respiratory tract infections. Methods The risk factors in patients with respiratory tract infections were analyzed and the bacterial of tuberculosis patients were isolated and tested. Results There were 125 cases （25.77%） of lower respiratory tract infection among 485 patients with tuberculosis. There were 165 （38.82%） strains of Gram-positive cocci, 228 （53.65%） strains of Gram-negative bacilli, 32 （7.53%） strains of fungal. Gram-positive bacteria had higher sensitivity to tolinezolid, Pseudomonas aeruginosa to aztreonam, ceftazidime and cefepime sensitive, Klebsiella pneumoniae more sensitive to cefepime, Escherichia coli was with higher sensitivity to imipenem, piperacillin and ciprofloxacin, Acinetobacter baumannii to all manifestations of resistance to conventional antibiotics. Age, duration of lesions, the type of antibiotic use and hospitalization time were the concurrent risk factors for tuberculosis infection in the lower respiratory tract. Conclusions Bacterial resistance were higher in patients with pulmonary tuberculosis complicated with respiratory tract infection. The management of the old age, long course of disease, lesions, long hospital stay in patients at high risk should be strengthen. Rational use of antibacterial drugs, strengthen the observation of patients with drug resistance, can effectively reduce the incidence of pulmonary tuberculosis accompanied with lower respiratory tract infection rate.