肺结核患者下呼吸道感染的病原菌药敏及危险因素分析  

Risk factors and drug resistance of pathogens causing lower respiratory tract infections in tuberculosis patients

作　　者：李四清[1] 花勤亮[1] 石艳[1] 徐连广[1] 

机构地区：[1]河南新乡医学院第一附属医院结核内二科,河南卫辉453100

出　　处：《中华医院感染学杂志》2013年第19期4844-4846,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技攻关项目(200803046)

摘　　要：目的探讨肺结核患者合并下呼吸道感染的病原菌及其耐药性,对合并下呼吸道感染的危险因素进行分析。方法对2009年1月-2012年12月住院治疗的肺结核患者送检的样本,做细菌分离鉴定与药敏试验,并分析危险因素。结果共分离出病原菌1056株,其中革兰阴性杆菌占56.6%,革兰阳性球菌占17.9%,真菌占25.5%;革兰阴性杆菌中前3位病原菌依次为铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌,分别占19.9%、15.2%和7.7%,革兰阳性球菌前3位为溶血葡萄球菌、金黄色葡萄球菌、表皮葡萄球菌,分别占3.3%、2.5%、1.5%,真菌主要为白色假丝酵母菌;多数病原菌对常用抗菌药物呈现出不同程度的耐药;年龄>45岁、病程>2年、病灶>6肺野、抗菌药物使用2种>2周及住院时间>30d是住院患者感染的危险因素。结论肺结核患者并发呼吸道感染的病原菌以革兰阴性杆菌多见,且细菌耐药性较高,应加强病原菌检测及耐药性观察,合理使用抗菌药物,降低肺结核患者医院感染的发病率。OBJECTIVE To investigate the drug resistance of the pathogens causing respiratory tract infections in tuberculosis patients and analyze the risk factors for the lower respiratory tract infections. METHODS The bacterial culture and the drug susceptibility testing were performed for the sputum specimens submitted from hospitalized tuberculosis patients from Jan 2009 to Dec 2012, the statistical analysis was performed. RESULTS Among the 1056 strains of pathogens isolated from hospitalized tuberculosis patients, there were gram-negative bacilli（56. 6%）, gram-positive cocci（17. 9%） and fungi （25. 5%）, the top 3 gram-negative bacilli were Pseudomons eruginos （19.9%）, Klebsiella pmeumomiae （15. 2%）, and Escherichia coli （17. 7%）, respectively, the top 3 gram- positive cocci were S. epiderrnidis（ 3. 3 ~ ） , Stuph ylococcus aureus （2.5%）, S. haemol yticus（1. 5 ~/~0 ） , and the Candida albicans was the predominant species of fungi, the pathogens varied in the drug resistance to common antibiotics. The more than 45 years of age, course of disease more than 2 years, lesions more than 6 lung field, use of antibacterial drugs more than two weeks, and hospitalization duration more than 30d were the risk factors for the nosocomail infection. CONCLUSION Gram-negative bacilli are predominant pathogens causing respiratory tract infections in tuberculosis patients, so it is necessary to strengthen the detection of pathogens and the surveillance of drug resistance, and reasonablv use of nntihint; ~ u_ ：. r ..

关 键 词：肺结核 病原菌 下呼吸道感染 耐药性 

分 类 号：R378[医药卫生—病原生物学]