HIV合并结核杆菌感染患者病原菌分布情况及其耐药性分析

目的 调查HIV合并结核感染患者体内的病原菌分布情况,并对患者的耐药情况进行分析。 方法 收集2014年1月—2016年1月河南省传染病医院收治的HIV/MTB双重感染及单纯结核患者136例,根据患者的感染情况将患者分为3组,56例HIV/MTB双重感染患者为HIV/MTB组,40例结核患者为MTB组,40例AIDS患者为HIV组。对3组患者进行标本采集,在MGIT管内开展相应的前处理后接种,采用绝对浓度法对培养阳性的菌株实施耐药性检测。统计患者体内的病原菌分布情况,并对其耐药性进行评价比较,记录实验结果,进行统计学分析。 结果 3组患者的一般临床资料均无结核病史。3组患者的性别、年龄等资料比较差异无统计学意义(P>0.05)。HIV/MTB组患者成功分离出菌株38例,其检出阳性率为67.86%,共分离出菌株83株,部分病原菌分布与MTB组和HIV组比较,差异存在统计学意义(P<0.05)。MTB组与HIV组患者成功分离出菌株22例、24例,其检出阳性率分别为56.41%、58.54%,共分离出菌株分别为39株、41株,2组患者均易感染革兰阴性菌,与HIV/MTB组不同,且革兰阳性菌对3组患者的感染能力较低。HIV/MTB组中有2例(3.57%)对RFP、INH、OFL、KAN均耐药,而MTB组和HIV组不存在。HIV/MTB组总初始耐药(包括耐INH、耐SM)与MTB组和HIV组比较,差异有统计学意义(P<0.05)。 结论 在HIV合并结核感染患者治疗时,应选择联合用药治疗,以针对革兰阴性致病菌为主,还应同时考虑真菌、病毒、耶氏肺孢子菌等病原体。 

Analysis and study of drug resistance in HIV patients complicated with tuberculosis infection

Objective To investigate the distribution of pathogenic bacteria in HIV patients complicated with tuberculosis infection, and to analyze the drug resistance of the patients. Methods One hundred and thirty-six cases of patients with HIV/MTB double infection and simple tuberculosis treated in our hospital from January, 2014 to January, 2016 were divided into three groups according to the patient's infection, which is 56 patients with HIV/MTB double infection as HIV/MTB group, 40 cases of tuberculosis patients as MTB group, and 40 cases of AIDS patients as HIV group. Three groups of patients were collected before carry out the corresponding pre treated inoculation in the MGIT tube, and using the absolute concentration method for the culture of the positive strains of drug resistance testing. Distribution of pathogenic bacteria in patients with statistics and evaluate the properties of the comparison, record the experimental results, statistical analysis, were conducted. Results The general clinical data of the three groups had no history of tuberculosis and diabetes, and no history of anti TB treatment. The gender and age of the three groups were not statistically significant (P > 0. 05). HIV/MTB group of patients with isolated strains in 38 cases, the positive rate was 67. 86%, 83 strains were isolated. Compared with the MTB group and the HIV group, there were significant differences in the distribution of the pathogenic bacteria (P < 0. 05). MTB group and HIV group were successfully isolated strains in 22 cases, 24 cases, the positive rate were 56. 41%, 58. 54%, a total of 39 strains and of bacteria were isolated and 41 strains. The two groups of patients were susceptible to Gram-negative bacteria, and the HIV/MTB group was different, and the gram positive bacteria in the three groups of patients with low infection ability. In HIV/MTB group, 2 cases (3. 57%) were resistant to RFP, INH, OFL and KAN, but not in MTB group and HIV group. The total initial drug resistance (including INH, resistant to SM) in the HIV/MTB group was significantly different from that in the MTB group and the HIV group (P < 0. 05). Conclusion In the treatment of HIV patients with tuberculosis infection, the use of antimicrobial agents should choose a combination of medication treatment. In order to aim at the gram negative pathogenic bacteria, we should also consider the fungi, viruses and other pathogens.