肺结核合并肺部感染的病原菌及其耐药性的观察分析

目的分析肺结核合并肺部感染病原菌分布特点及耐药性，为临床治疗提供参考依据。方法选择2011年3月～2013年4月间172例肺结核合并呼吸系统非结核分枝杆菌感染的患者，取合格痰标本进行普通细菌培养及药物敏感试验分析。结果痰标本中共分离出196株细菌。其中革兰阴性杆菌136株（69．39％），主要以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌为主；革兰阳性球菌52株（26．53％），以金黄色葡萄球菌为主；真菌8株（4．08％），以白色念珠菌为主。耐药性分析：金黄色葡萄球菌对青霉素全部耐药，对万古霉素完全敏感；革兰阴性菌中的主要菌株中，大肠埃希菌对亚安培南及阿米卡星高度敏感；肺炎克雷伯杆菌对哌拉西林呈高度耐药，对亚胺培南高度敏感，铜绿假单胞菌对阿莫西林／克拉维酸、头孢呋辛、头孢曲松高度耐药，对阿米卡星敏感。结论肺结核患者发生感染情况较复杂，感染的细菌菌株不同，对抗菌药的敏感性不同，建议及时行痰培养，结合药物敏感试验的结果合理选择抗菌药物，避免不合理用药，增加致病菌耐药的几率。

The analysis of pathogenic bacteria and drug resistance at pulmonary tu- berculosis complicated with pulmonary infection

Objective To analyze the pathogens distribution and resistance of pulmonary tuberculosis complicated with pulmonary infection, provides a reference for the clinical treatment. Methods Chose 172 cases of pulmonary tuberculosis with non-tuberculous mycobacterial respiratory infections from March 2011 to April 2013,with qualified sputum samples were ordinary bacterial cultured and drug sensitivity test ananlyzed. Results A total of 196 strains of bacteria were isolated from sputum specimens. Among which there were 136 strains of G-（69.39%）, mainly Klebsiella pneumo niae, Pseudomonas aeruginosa, E. coli; 52 strains （26.53%） were G＋, mainly staphylococcus aureus; 8 strains（4.08%） cases of fungus, mainly candida albicans. Drug resistance analysis： Staphylococcus aureus, resistant to penicillin, completely sensitive to vancomycin, resistant rate to zero.The main strains of G-,E coli was highly sensitive to Imipenem and amikacin. With klebsiella pneumoniae to piperacillin was highly resistant, highly sensitive to imipenem; Pseudomonas aeruginosa was highly sensitive to amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, highly resistant to amikacin, the resistant rate to zero. Conclusion 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.