对比艾滋病与肺结核合并重症肺炎行机械通气患者的病原分布及耐药性分析

目的:探讨艾滋病合并重症肺炎的病原分布特点及耐药性,为临床治疗艾滋病合并重症肺炎提供依据。方法:应用回顾性分析方法,选择2012年1月-2014年1月期间在我院住院的重症肺炎患者156例,按感染HIV或肺结核将患者分为A、B 2组,每组各78例,A组为艾滋病合并重症肺炎患者,B组为肺结核合并重症肺炎患者,检测156例重症肺炎并行有创机械通气患者的致病菌及对抗菌药物的耐药率。结果:分离出196株病原菌,其中痰标本分离出140株,占71.4%株,其余分别分离自血液、胸腔积液、肺穿刺组织学标本。A组134株病原菌中:真菌感染54株,革兰阴性杆菌34株(其中14株为ESBL表型阳性菌, 4株ESBL表型阳性菌为泛耐药菌株),革兰阳性菌15株(2株MRSA, 2株MRSE), 结核分支杆菌16株,巨细胞病毒14株,46例病例为2种以上病原感染;B组62株病原菌中:革兰阴性菌25株(其中4株为ESBL表型阳性菌,2株ESBL表型阳性菌为泛耐药菌株)、结核分枝杆菌20株、真菌11株、革兰阳性菌6株(1株MRSA),16例为2种以上病原感染。结论:艾滋病合并重症肺炎感染病原菌以革兰阴性杆菌为主,常合并2种或上2种多种病原菌感染,与肺结核合并重症肺炎患者比较,耐药现象明显。药敏试验结果可以为临床用药提供一定参考。

Analysis of distribution and drug resistance of pathogens in patients AIDS or tuberculosis complicating with severe pneumonia under invasive mechanical ventilation

OBJECTIVE To investigate the distribution and drug resistance of the pathogens in patients with AIDS complicating with severe pneumonia, provide evidences for the clinical treatment of AIDS patients with severe pneumonia. METHODS Retrospective analysis was applied to 156 hospitalized patients with severe pneumonia from January 2012 to January 2014. The patients were divided into group A and B according to pathogens the patients were infected. Each group included 78 patients. In group A, patients had AIDS and severe pneumonia; in group B, patients had tuberculosis and severe pneumonia. We detected the pathogens of those patients under invasive mechanical ventilation, and the antibiotics resistance rates of different pathogens. RESULTS A total of 196 strains of pathogenic bacteria were isolated from sputum (173 strains, 72.7%), blood, pleural effusion and pulmonary biopsy. A total of 134 strains were isolated in group A, including 54 fungi, 34 gram negative (G^-) bacteria (14 strains of Gram-positive in phenotypes of extended-spectrum beta-lactamase (ESBL), 4 pan-resistant strains),15 gram positive (G⁺) bacteria (2 strains of MRSA, 2 strains of MRSE), 16 mycobacterium tuberculosis and 14 cytomegalovirus. There were 46 patients infected by more than 2 kinds of pathogens. A total of 62 strains of pathogens were isolated in group B, including 25 gram negative (G^-) bacteria (4 strains of G⁺ in phenotypes of ESBL, 2 pan-resistant strains), 20 mycobacterium tuberculosis,11 fungi, 6 Gram positive (G⁺) bacteria (1 strain of MRSA). There were 16 patients infected by more than 2 kinds of pathogens. CONCLUSION Pathogens in AIDS patients with severe pneumonia are mainly negative (G^-) bacteria. The patients are usually infected by more than two pathogens. Drug resistance of pathogens is more significant than patients simultaneously with severe pneumonia and tuberculosis. The result of drug sensitive test can be referred for clinical medication.