肺结核下呼吸道感染及抗菌药物合理应用研究

目的研究肺结核患者继发肺部感染时的常见病原体种类及其敏感药物,为临床抗菌药物合理应用提供依据。方法对我院住院肺结核患者下呼吸道标本分离出致病菌者752例按G+球菌、G-杆菌和真菌分组分析,并按种类进行药敏试验,分析感染菌谱和耐药状况。结果分离出的病原体中,以G-杆菌为主,占50.0%,其次是真菌和G+球菌,分别占25.0%和21.7%;白色念珠菌、铜绿假单胞菌和肺炎克雷伯杆菌占前3位;药敏结果显示,G-杆菌对亚胺培南、阿米卡星敏感性较高;G+菌对万古霉素敏感性较高;白色念珠菌对5-氟胞嘧啶最为敏感。结论明确肺结核患者下呼吸道感染的病原体种类和药物敏感试验结果,选择合理有效的抗菌药物,是及时治疗、挽救患者生命的关键。

The status of pulmonary tuberculosis patients with secondary pulmonary infection and rational use of antibiotics

Objective To study the types of common pathogens and their drug-sensitive in pulmonary tuberculosis patients with secondary pulmonary infection,and so as to provide reference for rational use of antibiotics in clinic.Methods The pathogens isolated in lower respiratory tract specimens from the 752 pulmonary tuberculosis patients with secondary pulmonary infection in our hospital was grouped by gram-positive cocci,gram-negative bacteria and fungi groups,and performed susceptibility testing in accordance with the types of pathogens,the bacterial spectium of infection and drug resistance was analyzed.Results Major pathogens iso1ated were G-bacillus（50.0%） and subsequent pathogens were fungi and gram-positive cocci（25.0% and 21.7%）;the top three infectious pathogens was Candida albicans,Pseudomonas aeruginosa and Klebsiella pneumoniae;Drug sensitivity test displayed as follows：the sensitive drugs for G-bacillus in sequence was imipenem and amikacin;the sensitive drugs for G＋ bacterium in sequence were vancocin and clarithromycin;The resistance of Candida albicans to KTC,ECO and ITC were stronger than to AMB,5-FC,FLC and NYS.Conclusion A clear understanding of the types of bacterial infections and the results of their drug sensitivities in pulmonary tuberculosis patients with secondary pulmonary infection,and rational choice of antibiotics is the key to timely treatment and to save lives of patients.