肺结核患者下呼吸道革兰阴性杆菌感染的临床研究及耐药性分析  

Clinical research on distribution and drug resistance of gram-negative bacilli causing lower respiratory tract infections in pulmonary tuberculosis patients

作　　者：李慧娟[1] 周东鹏[1] 

机构地区：[1]河南省胸科医院检验科,河南郑州450003

出　　处：《中华医院感染学杂志》2014年第2期306-308,共3页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关基金项目(201001014)

摘　　要：目的探讨肺结核患者下呼吸道感染革兰阴性杆菌的分布及其对抗菌药物的耐药现状,为抗菌药物合理使用提供理论依据,防止多药耐药菌株的传播。方法细菌培养严格按照《全国临床检验操作规程》进行,细菌鉴定采用法国生物梅里埃公司的API板条和软件系统,药敏试验采用K-B法,依据CLSI最新版本进行结果评价。结果共分离出革兰阴性杆菌596株,排名前4位病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌,分别占32.2%、17.3%、14.3%、11.4%;肺炎克雷伯菌和大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)的菌株依次是65株和26株,阳性率分别占33.9%和30.6%,产ESBLs的细菌对常用抗菌药物的耐药率普遍高于非产ESBLs菌,除了头孢吡肟、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南/西司他丁的耐药率<38.5%,产ESBLs菌对其余常用抗菌药物的耐药率均>46.2%;非发酵菌中鲍氏不动杆菌呈耐多药状态,头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦的耐药率依次为20.6%、25.0%和35.3%,其余10种常用抗菌药物的耐药率均>58.8%。结论头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦是治疗结核病患者革兰阴性杆菌感染时的最有效药物,临床医师应根据药敏试验结果合理使用抗菌药物,减少耐药菌株的产生。OBJECTIVE To investigate the distribution and antimicrobial resistance of gram-negative bacilli infection in lower respiratory tract of pulmonary tuberculosis patients so as to provide evidence for rational use of antibiotics in clinic and to prevent the spread of the multidrug-resistant bacteria. METHODS Bacterial culture was performed according to National Guide to Clinical Laboratory Procedures. The API kits and relative software （France, Merieux） were used to identify the bacteria. The drug susceptibility tests were performed by K-B method. The tes- ting results were assessed according to the latest version of CLSI. RESULTS A total of 596 strains of gram-negative bacilli were isolated, the top four species of pathogenic bacteria included the Klebsiella pneumoniae （32.2%）, Pseudomonas aeruginosa （17.3 % ）, Escherichia coli （ 14.3 % ）, and Acinetobacter baumannii （ 11.4 % ）. ESBLs- producing K. pneumoniae and E. coli strains were 33.9% and 30.6%, and they were 65 and 26 strains, respec- tively. The resistance of ESBLs-positive strains to common antimicrobial was higher than those of ESBLs-negative strains. For ESBLs-producing bacteria, the resistant rates to cefepime, piperacillin-tazobactam, cefoperazone-sul- bactum, and imipenem were less than 38.5 %, while to all other antimicrobial it was over 46.2 %. In non-fermen- ting gram-negative bacilli, A. baumannii were resistant to most antimicrobial, the resistant rates to cefoperazone- sulbaetum, imipenem, piperacillin-tazobactam were 20.6%, 25.0% and 35.3%, respectively, to all other 10 common antimierobials, the resistant rates were higher than 58.8 %. CONCLUSION Cefoperazone-sulbactum, imi- penem, and piperaeillin-tazobactam remain high antibacterial activity against gram-negative bacteria to pulmonary tuberculosis patients. It is important for the clinical doctors to choose antimicrobiat according to drug susceptibilitytesting results so as to reduce the drug resistant strains.

关 键 词：肺结核患者 革兰阴性杆菌 抗菌药物 耐药性 

分 类 号：R378[医药卫生—病原生物学]