241例肺结核合并下呼吸道感染患者328株病原菌分布及耐药性分析  

Distribution and analysis of drug resistance of 328 pathogen strains in 241 pulmonary tuberculosis patients complicated with lower respiratory tract infection

作　　者：王湘[1] 冯爽[1] 

机构地区：[1]天津市海河医院,天津300350

出　　处：《口岸卫生控制》2014年第4期30-34,共5页Port Health Control

摘　　要：目的了解肺结核患者合并下呼吸道感染常见病原菌及其耐药性。方法对本院2012年全年住院的确诊肺结核患者送检的痰或灌洗液标本细菌培养和药敏试验进行统计分析。结果 2012年全年肺结核患者中共分离328株病原菌,其中革兰氏阴性杆菌207株占63.1%,革兰氏阳性菌13株占4.0%,真菌108株占32.9%;革兰氏阴性杆菌中以肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希氏菌为主,分别占18.6%、12.5%、8.2%、5.8%、3.7%;革兰氏阳性球菌中以金黄色葡萄球菌、溶血葡萄球菌为主,分别占2.1%、0.6%;真菌中以白色念球菌、热带念球菌、克柔念球菌为主,分别占27.4%、2.7%、2.1%。不同病原菌对常用抗菌素的耐药性不同。结论肺结核患者呼吸道致病菌种以革兰阴性杆菌居多,呈多重耐药,临床上肺结核合并感染的患者中,应选用对革兰氏阴性杆菌效果较好的药物,并尽可能根据药敏试验选药,以避免不合理应用抗菌药物导致细菌耐药的产生。Objective This article intends to understand the distribution of pathogens and drug resistance in pa- tients with pulmonary tuberculosis patients complicated with lower respiratory tract infection. Methods Choose the qualified Sputum or BAL fluid samples of patients with pulmonary tuberculosis in the year of 2012 for bacteriological culture and drug sensitivity test. Results In 2012, 328 pathogen strains in pulmonary tuberculosis patients are isolated, including 207 strains of gram negative bacilli accounted for 63.1% , 13 strains of Gram -positive bacteria accounted for 4% , 108 strains of fungi accounted for 32.9%. The dominant species of the gram negative bacilli are Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter, Bauman, ,Escheriehia co- accounted for 18.6%, 12.5%, 8.2%, 5.8%, 3.7% respectively; Staphylococcus aureus, Staphylococcus haemolyticus are the dominant species of gram positive cocci, accounted for 2.1% , 0.6% respectively; the domi- nant species of fungus are Candida albicans, Candida krusei, tropical Candida, accounted for 27.4%, 2.7% , 2.1% respectively. Resistance of different pathogenic bacteria is different to commonly used antibiotics. Conclusion Pulmonary tuberculosis patients with respiratory tract pathogenic bacteria are mainly infected with gram -negative bacilli which is muhidrug resistant. Tuberculosis patients complicated with infection should choose the gram negative bacillus drugs, as far as possible, according to the drug sensitivity test in order to avoid the ap- pearance of drug resistant bacteria due to the unreasonable use of antibacterial drugs.

关 键 词：肺结核 呼吸道感染 病原菌 耐药性 

分 类 号：R521[医药卫生—内科学]