2010-2013年郧西县肺结核合并下呼吸道感染患者的病原菌谱分析和耐药性研究

目的对肺结核合并下呼吸道感染患者的病原菌特点进行分析,并对其耐药性进行研究。方法对1 273例肺结核合并下呼吸道感染患者的痰液标本进行病原菌株分离,并对其分布和耐药性进行研究。结果 1 273例标本中共分离培养出菌株408株,其中62例患者携带2种病原菌,8例患者携带3种病原菌,其他为1种病原菌,总阳性率为25.9%(330/1273)。其中革兰阴性菌185株(45.3%),主要为铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌;革兰阳性菌147株(36.0%),主要为金黄色葡萄球菌、肺炎链球菌;真菌76株(18.6%),主要为白色念珠菌。耐药性试验结果表明,亚胺培南和阿米卡星能有效治疗革兰阴性菌感染,替考拉宁和万古霉素能有效治疗革兰阳性菌感染。结论肺结核合并下呼吸道感染的细菌具有较高的耐药性,临床治疗应结合耐药检测结果进行用药。

Analysis of pathogenic bacteria and their drug resistance in patients with tuberculosis combined with lower respiratory infection in epidemic prevention station of Yunxi from 2010 to 2013

Objective To investigate the pathogenic bacteria distribution and their drug resistance in patients with tuberculosis combined with lower respiratory infection. Methods 1 273 cases with tuberculosis combined with lower respiratory tract infections in our epidemic prevention station from 2010 to 2013 were retrospectively analyzed. The sputum of all patients was collected, cultured, and the bacteria were isolated and analyzed. Results Total 408 pathogen strains were detected, including 185 Gram-negative bacteria （45.3%）, 147 Gram-positive bacteria （36.0%） and 76 fungi （18.7%）. The top 3 Gram-negative bacteria were Pseudomonas aeruginosa （17.4%）, Acinetobacter baumannii （15.2%） and Klebsiella pneumonia （7.6%）; the top 2 Gram-positive bacteria were Staphylococcus aureus （19.4%） and Streptococcus pneumonia （8.8%）; the top fungus was Monilia albican （18.6%）. 62 patients carry two kinds of pathogens, 8 patients carry three kinds of pathogens, the other carry one kind of bacteria, total positive rate of 25.9% （330/1273）. Resistance test results showed that imipenem and amikacin could be used to effectively treat Gram-negative bacterial infections, linezolid and vancomycin could be used to effective in the treatment of Gram-positive bacterial infections. Conclusion Most bacteria in patients with tuberculosis combined lower respiratory infection show a certain resistant to many antibiotics. Therefore, the clinical treatment should base on the resistance test results.