2010-2014年黄石市老年肺结核合并下呼吸道感染的病原菌谱分析和耐药性研究

目的探讨我市老年肺结核合并下呼吸道感染患者病原菌分布及常规药物的敏感性。方法收集我中心2010年1月-2014年1月1758例老年肺结核合并下呼吸道感染患者的痰液标本,进行病原菌的培养和分离,并对其耐药性进行测试。结果 1758例标本中共分离培养出病原菌743株,其中携带2种病原菌患者71例,携带3种病原菌患者25例,携带4种病原菌患者5例,其他均携带1种病原菌,患者总阳性率为34.5%(607/1758)。革兰阴性菌有341株(45.9%),主要为铜绿假单胞菌131株(17.6%)、鲍曼不动杆菌108株(14.5%)和肺炎克雷伯菌58株(7.8%);革兰阳性菌有272株(36.6%),主要是金黄色葡萄球菌149株(20.1%),肺炎链球菌65株(8.7%);真菌130株(17.5%),主要为白假丝酵母菌89株(12.0%)。进一步的耐药性测试结果表明:革兰阴性菌对亚胺培南、阿米卡星有很好的敏感性,革兰阳性菌对替考拉宁、万古霉素有很好的敏感性。结论老年肺结核合并下呼吸道感染病原菌耐药性较高,临床治疗应根据患者病原菌的耐药结果进行用药治疗。

Analysis of pathogenic bacteria and their drug resistance in elderly patients with tuberculosis complicated with lower respiratory infection in Huangshi city from 2010 to 2014

Objective To investigate the distribution of pathogenic bacteria and their drug resistance in patients with tuberculosis combined with lower respiratory infection. Methods A total of 1,758 cases of tuberculosis combined with lower respiratory tract infections in our epidemic prevention station from Jan 2010 to Jan 2014 were retrospectively analyzed. The sputa of all the patients were collected, cultured and then analyzed. Results From the samples, 743 strains of pathogens were detected out. There were 71 patients with two pathogens, 25 patients with three pathogens, 5 patients with four pathogens. The overall positive rate of was 34.5% （607/1,758） among the patients. The gram-negative bacteria took up 341 strains （45.9%）, mainly including pseudomonas aeruginosa 131 （ 17.6% ） , aeinetobaeter baumannii 108 （ 14.5% ） , and klebsiella pneumonia 58 （7.8%） ; gram-positive bacteria took up 272 strains （36.6%） , mainly including staphylococcus aureus 149 （20.1% ） , and streptococcus pneumonia 65 （ 8.7% ） ; fungi took up 130 strains （ 17.5% ）. Resistance test results showed that imipenem and amikacin were effective on gram- negative bacterial infections, and that linezolid and vancomycin were effective on gram-positive bacterial infections. Conclusion Most bacteria in patients with tuberculosis combined with lower respiratory infection show a certain resistance to many antibiotics. Therefore, the clinical treatment should be based on the resistance test results.