耐多药肺结核合并糖尿病患者肺部感染病原菌与危险因素分析  

Distribution of pathogens causing pulmonary infections in multidrug-resistant tuberculosis patients complicated with diabetic mellitus and risk factors

作　　者：盛云峰[1] 邱美华[1] 鲍志坚[1] 孙丽芳[1] 杨盛娅 

机构地区：[1]杭州市红十字会医院结核科,浙江杭州310003

出　　处：《中华医院感染学杂志》2016年第9期1939-1941,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅医药卫生科技计划基金资助项目(2013KYA209);浙江省杭州市科学技术基金资助项目(20120533Q26)

摘　　要：目的分析耐多药肺结核(MDR-TB)合并糖尿病患者肺部感染病原菌与危险因素,为预防肺部感染提供依据。方法选取医院2010年6月-2015年6月收治的471例MDR-TB合并糖尿病患者,按照其肺部感染发生情况分为感染组与未感染组,观察感染组病原菌特点,并使用多因素logistic回归分析总结影响患者肺部感染的危险因素。结果 471例MDR-TB合并糖尿病患者中有130例患者发生肺部感染,感染率为27.60%;共分离病原菌139株,其中革兰阴性菌占52.52%,革兰阳性菌占37.41%,真菌占10.07%;革兰阳性菌对乙酰唑胺、替考拉宁均无耐药性,对青霉素G、氨苄西林耐药性最高;革兰阴性菌对美罗培南无耐药性,对替考拉宁耐药性较低,对土霉素、红霉素耐药性最高;真菌对克霉唑无耐药性,对益康唑、酮康唑耐药性最高;年龄≥65岁、病程≥5年、空洞数量≥3肺野、餐后2h血糖≥11.1mmol/L、住院时间≥14d、合并症、侵入性操作、预防性应用抗菌药物均是影响MDR-TB合并糖尿病患者发生肺部感染的独立危险因素(P<0.05)。结论 MDR-TB合并糖尿病患者具有较高的肺部感染率,针对其感染的危险因素及病原菌特点,行合理的预防与针对性治疗,有望降低肺部感染率,改善患者的预后质量。OBJECTIVE To investigate the distribution of pathogens causing pulmonary infections in the multidrugresistant tuberculosis（MDR-TB）patients complicated with diabetic mellitus and analyze the risk factors so as to provide guidance for prevention of pulmonary infections.METHODS A total of 471 MDR-TB patients complicated with diabetic mellitus who were treated in the hospital from Jun 2010 to Jun 2015 were enrolled in the study and divided into the infection group and the non-infection group according to the incidence of pulmonary infections.The distribution of the pathogens causing the infections was observed,and the multivariate logistic regression analysis was performed for the risk factors for the pulmonary infections.RESULTS Of the 471MDR-TB patients complicated with diabetic mellitus,130 had pulmonary infections,with the infection rate 27.60%.Totally 139 strains of pathogens were isolated,of which 52.52% were gram-negative bacteria,37.41% were gram-positive bacteria,and 10.07% were fungi.The gram-positive bacteria were not resistant to acetazolamide and teicoplanin,while the drug resistance rates to penicillin G and ampicillin were the highest.The gram-negative bacteria were not resistant to meropenem,the drug resistance rate to teicoplanin was relatively low,and the drug resistance rates to oxytetracycline and erythromycin were the highest.The fungi were not resistant to clotrimazole,while the drug resistance rates to econazole and ketoconazole were the highest.The independent risk factors for the pulmonary infections in the MDR-TB patients complicated with diabetic mellitus included the no less than 65 years of age,disease course no less than 5years,number of cavities no less than 3lung field,level of 2hpostprandial blood glucose no less than 11.1mmol/L,length of hospital stay no less than 14 days,complications,invasive operations,and prophylactic use of antibiotics（P〈0.05）.CONCLUSION The incidence rate of pulmonary infections is relatively high in the MDR-TB patients complicated with diabetic melli

关 键 词：耐多药肺结核 糖尿病 病原菌 危险因素 

分 类 号：R521[医药卫生—内科学]