结核性脑膜炎患者呼吸道感染病原菌分析  

Pathogenic bacteria in nosocomial respiratory tract infections in patients with tuberculous meningitis

作　　者：邱英梅[1] 徐亮[1] 熊莉[1] 周璞[2] 肖慧华[3] 

机构地区：[1]江西省胸科医院医院感染管理科,江西南昌330006 [2]淄博职业学院电子电气工程学院,山东淄博255000 [3]江西中医药大学附属医院医院感染管理科,江西南昌330006

出　　处：《中华医院感染学杂志》2016年第3期597-598,601,共3页Chinese Journal of Nosocomiology

基　　金：国家科技支撑计划基金资助项目(2012BAI22B05)

摘　　要：目的探讨结核性脑膜炎患者呼吸道感染的临床特点,为临床医师选择使用抗菌药物预防医院感染提供依据。方法分析138例结核性脑膜炎呼吸道感染患者的临床资料、病原菌分布及耐药特点,数据采用SPSS15.0统计软件进行处理。结果 138例患者痰液培养出病原菌92株,培养阳性率为66.67%,其中革兰阴性菌80株占86.96%,革兰阳性菌6株占6.52%,真菌6株占6.52%;革兰阴性菌中鲍氏不动杆菌检出33株最多,占35.87%,其次为铜绿假单胞菌17株占18.48%,肺炎克雷伯菌15株占16.30%,大肠埃希菌8株占8.70%;革兰阳性菌均为金黄色葡萄球菌;革兰阴性菌中鲍氏不动杆菌对常用抗菌药物普遍耐药,铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌对头孢哌酮/舒巴坦耐药率低,均<13.00%;金黄色葡萄球菌对万古霉素均敏感,对苯唑西林耐药率高;6株白色假丝酵母菌对氟康唑耐药率为32.00%,对两性霉素B敏感。结论结核性脑膜炎患者呼吸道感染病原菌以革兰阴性菌为主,病原菌对头孢哌酮/舒巴坦较为敏感,提示临床医师在治疗过程中对难治性感染可选用头孢哌酮/舒巴坦。OBJECTIVE To investigate the clinical characteristics of nosocomial respiratory tract infections in patients with tuberculous meningitis,and to provide evidences for the use of antimicrobial agents in clinical practice to prevent nosocomial infections.METHODS The clinical data of 138 patients with tuberculous meningitis combined with nosocomial respiratory tract infections were analyzed retrospectively.The distribution and drug resistance of pathogenic bacteria were analyzed.The software SPSS15.0 was used for statistical analysis of data.RESULTS Totally 92 strains of pathogenic bacteria were cultured in 138 sputum specimens,the positive rate was 66.67%,including 80 strains of gram-negative bacteria（86.96%）,6strains of gram-positive bacteria（6.52%）,6strains of fungi（6.52%）.Totally 33 strains of Acinetobacter baumanii were the most cultured among gram-negative bacteria,accounting for 35.87%,followed by Pseudomonas aeruginosa（17strains,18.48%）,Klebsiella pneumoniae（15strains,16.30%）,and Escherichia coli（8strains,8.70%）.Gram-positive bacteria were all Staphylococcus aureus.In gram-negative isolates,A.baumanii were generally resistant to commonly used antibiotics.The drug resistance rate of P.aeruginosa,K.pneumoniae and E.coli to cefoperazone/sulbactam was low,being less than 13.00%.S.aureus were sensitive to vancomycin,but highly resistant to oxacillin.The 6strains of Candida albicans had a resistance of 32.00%to fluconazole and were sensitive to amphotericin B.CONCLUSIONPathogens of nosocomial respiratory tract infections in patients with tuberculous meningitis were mainly gram-negative bacteria,and they were sensitive to cefoperazone/sulbactam,suggesting clinicians use cefoperazone/sulbactam to treat refractory infections during the healing process.

关 键 词：结核性脑膜炎 呼吸道感染 病原菌 

分 类 号：R378[医药卫生—病原生物学]