肺结核合并鲍曼不动杆菌感染的临床特点及对常用抗生素的耐药性分析

目的 探讨肺结核患者合并鲍曼不动杆菌（Ab）感染的临床特点,以及分析鲍曼不动杆菌对常用抗生素的耐药性.方法 收集2009年1月至2012年12月入住山东省胸科医院的肺结核合并鲍曼不动杆菌感染患者129例,采集合格痰标本分别接种至血琼脂、巧克力琼脂及麦康凯琼脂培养基分离培养,采用VITEK 32全自动微生物分析系统进行药物敏感性试验,将鲍曼不动杆菌对常用抗生素如头孢哌酮舒巴坦和亚胺培南等共计18种药物的敏感性试验数据进行耐药性分析.数据采用世界卫生组织细菌耐药性监测软件WHONET5.6软件进行分析.结果 129例患者中共分离出138株鲍曼不动杆菌,2009年25株（18.1％）,2010年32株（23.2％）,2011年39株（28.3％）,2012年42株（30.4％）.鲍曼不动杆菌对常用抗生素耐药率逐年上升,其中耐药率上升最快的为头孢哌酮舒巴坦和亚胺培南.2009年对上述药物的耐药率分别为4.0％（1/25）、12.0％（3/25）;2010年分别为9.4％（3/32）、18.8％（6/32）; 2011年分别为26.6％（10/39）、28.2％（11/39）;2012年分别为50.0％（21/42）、45.2％（19/42）.结论 与2009年相比,2012年结核病合并鲍曼不动杆菌感染患者比率明显上升,对常用抗生素的耐药率也逐年上升.

Analysis of clinical characteristics and drug resistance in the patients with pulmonary tuberculosis complicated with Acinetobacter baumannii infection in Shandong Chest Hospital

Objective To investigate the clinical characteristics of pulmonary tuberculosis complicated with Acinetobacter baumannii （Ab） infection,and to analyze Ab resistance to commonly used antibiotics.Methods One hundred and twenty nine cases with pulmonary tuberculosis complicated with Ab infection were retrospectively analyzed from January 2009 to December 2012.The sputum specimens were inoculated in blood agar,chocolate agar and MacConkey agar.The susceptibility tests of 18 drugs including cefoperazone shubatan and imipenem were performed by VITEK 32 automatic microorganism analysis system.Results One hundred and thirty eight Ab strains were isolated from 129 patients,25 strains （18.1％） in 2009,32 strains （23.2％） in 2010,39 strains （28.3％） in 2011,and 42 strains （30.4％） in 2012.Ab resistance to commonly used antibiotics increased year by year.The rates of Ab resistance to cefoperazone shubatan and imipenem were respectively 4.0％ （1/25） and 12.0％ （3/25） in 2009,9.4％ （3/32） and 18.8％ （6/32） in 2010,25.6％ （10/39） and 28.2％ （11/39） in 2011,50.0％ （21/42） and 45.2％（19/42） in 2012.Conclusion Compared with 2009,the ratio of tuberculosis complicated with Ab infection increased significantly in 2012.Ab resistance to commonly used antibiotics increased year by year.