广西贺州市150例艾滋病患者合并血流感染病原菌及耐药性分析

目的 了解贺州市艾滋病（AIDS）患者合并血流感染（BSI）病原菌分布及耐药性,为合理用药、有效控制AIDS患者血流感染提供科学依据。方法 收集2019年1月—2021年6月贺州市人民医院经血培养阳性150例AIDS 住院患者资料,并对血培养分离的病原菌种类和耐药情况进行统计分析。结果 150例AIDS患者,男性117例,女性33 例,男女比为3.5∶1;以18~<60岁年龄段患者为主（占77.3%）。150份血培养阳性标本共分离155 株病原菌,分别为真菌134株（占86.45%）、革兰氏阴性菌13株（占8.39%）、革兰氏阳性菌8株（占5.16%%）,其中5株马尔尼菲篮状菌（TM）合并其他菌感染。除TM无药敏结果外,新型隐球菌、念珠菌等真菌对临床常用的抗真菌药物敏感性好,耐药率低。G^-菌对碳青霉烯类、第四代头孢菌素类、第三代头孢菌素类、头霉素类、喹诺酮类药物、头孢哌酮钠/舒巴坦、哌拉西林/他唑巴坦等药物敏感性较好;G^-菌对氨曲南、不含酶抑制剂的青霉素类或头孢菌素类、磺胺类药物耐药菌株较多。G⁺菌对万古霉素、利奈唑胺、替考拉宁、左氧氟沙星的敏感性好,可视病情轻重选择相应药物进行治疗,但对磺胺类、青霉素G的耐药高。结论 贺州市AIDS合并BSI患者男性多于女性、中年患者为主;BSI病原菌以真菌为主,G^-菌和G⁺菌较少。临床常用抗真菌药物可用于经验性治疗;碳青霉烯类、第四代头孢菌素类、第三代头孢菌素类、头霉素类、喹诺酮类、头孢哌酮钠/舒巴坦、哌拉西林/他唑巴坦等可用于G^-菌的中重度感染治疗;万古霉素、利奈唑胺、替考拉宁、左氧氟沙星等可用于G⁺菌感染治疗;而氨苄西林、磺胺类、青霉素G的耐药菌株较多,不宜用于一般细菌抗感染治疗。

Distribution and drug resistance of bloodstream infection of 150 AIDS patients in Hezhou,Guangxi

Objective To understand the distribution of pathogenic bacteria and their drug resistance in AIDS patients with bloodstream infection (BSI) in Hezhou, and we provide scientific basis for rational drug use and effective control of AIDS patients bloodstream infection in local medical institutions. Methods The data of 150 patients with AIDS who had positive blood culture were collected from Hezhou People's Hospital in Hezhou since January 2019 to June 2021. The data of sex, age, pathogens and bacteria isolated from blood culture were analyzed. Results Among the 150 patients, 117 were male and 33 were female, the ratio of male to female was 3.5∶1, the majority were 18-<60 years middle-aged patients (77.3%) . A total of 155 pathogens were isolated from 150 positive blood culture specimens, including 134 fungi (86.45%) , 13 Gram-negative (8.39%) and 8 Gram-positive bacteria (5.16%) , among them, 5 strains of Talaromyces marneffei (TM) were infected with other bacteria. Except the drug-sensitive results of Talaromyces marneffei, Cryptococcus Neoformans, Candida and other fungi were sensitive to clinical commonly used fungicide, drug resistance rate was low. G^- bacteria were sensitive to Carbapenem, fourth generation cephalosporins, third generation cephalosporins, cephalosporins, quinolones, cefoperazone Sodium/sulbactam, Piperacillin/tazobactam, etc. , depending on the severity of the disease, the appropriate drugs should be selected for treatment. G^- bacteria were more resistant to Aztreonam, penicillins or cephalosporins without enzyme inhibitors, and sulfonamide. The above drugs should not be used for the treatment of G^- bacteria infection. G⁺ bacteria had good sensitivity to Vancomycin, Linezolid, teicoplanin, Levofloxacin, depending on the severity of the disease to choose the appropriate drug treatment, but to Sulfonamides, penicillin G were resistance high. Conclusion s The incidence of BSI in AIDS patients in Hezhou was higher in male than in female, and the proportion of BSI in middle age was the highest. Commonly used clinical Fungicide may be routinely used in empiric therapy; Carbapenems, fourth-generation cephalosporins, third-generation cephalosporins, cephalosporins, quinolones, cefoperazone Sodium/sulbactam, Piperacillin/tazobactam and other drugs can be used in the treatment of moderate to severe infections of G- bacteria empiric therapy; Vancomycin, Linezolid, teicoplanin, Levofloxacin and other drugs can be used for G+ bacteria infection of empiric therapy, and Ampicillin, sulfonamides, penicillin G resistant strains were relatively more, should not be used for anti-infective treatment of target bacteria.