肺结核合并呼吸道感染的288株病原菌分布及耐药性分析

目的通过对288株肺结核合并呼吸道感染的病原菌分布及其耐药性情况进行统计分析，以指导临床合理用药。方法对2012年7—12月肺结核合并呼吸道感染患者送检痰标本中分离鉴定的致病菌288株及药敏试验结果进行归纳分析。结果肺结核继发呼吸道感染的患者痰标本中共培养出288株菌株，革兰阴性菌226株，占78．47％，革兰阳性菌株18株，占6．25％，真菌44株，占15．28％。革兰阴性菌中肺炎克雷伯杆菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌为主；革兰阳性菌主要为肺炎链球菌、金黄色葡萄球菌、表皮葡萄球菌；真菌主要为白色念珠菌。药敏结果细菌种类情况各不相同，用药应根据细菌种类来确定。结论肺结核合并呼吸道感染的病原菌以革兰染色阴性菌为主。检出病原菌对抗菌药物的耐药性较强，临床医生应根据细菌培养和药敏结果采取合理抗生素治疗。

DISTRIBUTION OF 288 STRAINS PATHOGENS CAUSING RESPIRATORY INFECTION AND THE DRUG-RESISTANCE IN PATIENTS WITH PULMONARY TUBERCULOSIS

Objective To evaluate characteristic of the pathogens causing respiratory infection and the drug-resistance in patients with pulmonary tuberculosis for guiding clinical rational antibiotic drugs use. Methods 288 strains pathogens were isolated from the specimens collected in the patients with pulmonary tuberculosis and the results of drug sensitivity tests from May to December 2012 were sum-marized and analyzed. Results In all the detected specimens, 288 pathogenic strains were isolated （taking the first strain in the same patient）, including 266 strains of Gram-negative bacteria （78.47%）, 18 strains of Gram- positive bacteria（6.25%） and 44 strains of fungus（15.28%）. The Gram-negative bacteria were mainly Klebsiellar pneumonia, Enterobacter cloacae, P. Aeruginosa, Acinetobacter baumannii, and Escherichia coll. The Gram- positive bacteria were dominated by Staphyloccocus aureus, Staphyloccocus epidermidis and Streptococcus pneumoniae. The fungus was mainly canidia Albicans. The results of drug sensitivity tests were different with various kinds of bac- teria. Antibacterial medication should be selected according to the types of bacteria. Conclusion The pathogens causing respiratory infection in patients with pulmonary tuberculosis are mainly Gram- negative bacteria. The detected bacteria have high resistance to antibacterial agents. Doctor should pay attention to the results of bacteria culture and drug sensitive tests and according to the results select the rational antibiotic drugs.