云南省HIV/AIDS患者下呼吸道感染病原菌分布及耐药分析

目的：研究云南省HIV/AIDS合并下呼吸道感染住院患者病原菌分布及耐药性特点，指导临床用药．方法收集2008年1月至2012年12月在昆明市第三人民医院艾滋病科住院的HIV/AIDS合并下呼吸道感染住院患者278例进行痰液，肺泡灌洗液标本涂片、培养，阳性标本进行回顾性分析．结果278例痰液及肺泡灌洗液标本共分离出细菌127株（45.7%），真菌53株（19.1%），白色假丝酵母菌50株，曲霉菌3株．分支杆菌49株，结核分枝杆菌44株，其余为非典型分支杆菌．革兰氏阴性杆菌占64.6%，依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、不动杆菌属、阴沟肠杆菌，革兰阳性菌占15.4%．真菌占19.1%，常见为白色念珠菌．结核分枝杆菌占17.6%．革兰阴性杆菌对亚胺培南、头胞哌酮/舒巴坦、阿米卡星较敏感，革兰阳性菌对万古霉素、呋喃妥因、亚胺培南较敏感．结论云南省HIV/AIDS患者合并下呼吸道感染病原菌主要为革兰阴性杆菌，真菌感染比例逐年增高，以条件致病菌为主，对抗菌药物产生了不同程度的耐药，结核杆菌感染发病率高，存在耐多药结核菌，临床应合理使用抗菌药物，以延缓病原菌耐药的产生．

Pathogenic Bacteria Distribution and Drug Resistance Analysis in HIV/AIDS Patients with Lower Respiratory Tract Infection in Yunnan Province

Objective To study the pathogenic bacteria distribution and drug resistance characteristics in HIV/AIDS patients with lower respiratory tract infection in Yunnan province, so as to guide the clinical medication. Methods We collected 278 cases of hospitalized patients with sputum,alveolar lavage specimen smear, culture, positive specimens from HIV/AIDS patients with lower respiratory infection in The Third People’s Hospital of Kunming from January 2008 to December 2012. Then we retrospectively analyzed the collected data. Results From 278 cases of sputum and alveolar lavage fluid specimens,we isolated a total of 127 strains of bacteria （45.7%）, 53 strains of fungus （19.1%）,50 strains of white candida,3 strains of aspergillus,49 strains of mycobacterium, 44 strains of mycobacterium tuberculosis,and the rest of atypical mycobacteria. Gram negative bacilli accounted for 64.6%,followed by pneumonia klebsiella bacteria, pseudomonas aeruginosa,e. coli,acinetobacter,sewer,e. coli, gram-positive bacteria accounted for 15.4%. Fungi accounted for 19.1%, and candida albicans was the common fungus. Mycobacterium tuberculosis accounted for 17.6%. Gram-negative bacilli were sensitive to imipenem, ptilinum ketone/sulbactam and amikacin,gram-positive bacilli were sensitive to vancomycin, nitrofurantoin and imipenem. Conclusions The major pathogenic bacteria are gram-negative bacilli in HIV/AIDS patients with lower respiratory tract infection in Yunnan province,but fungal infection ratio is increasing year by year, and conditional pathogenic bacteria are the major pathogen,which have antimicrobial resistance with different degree,TB infection＆amp;nbsp;rate is high and multi-drug resistant TB appears. Antimicrobial agents should be rationally used to delay the appearance of pathogen resistance.