肺结核患者合并感染病原菌分析  

Pathogens causing pulmonary infections in tuberculosis patients

作　　者：薛娜娜[1] 刘宁[1] 马京华[1] 梁会贞[1] 陈彦彩 刘玉芳[1] 

机构地区：[1]河北省胸科医院结核五科,河北石家庄050041

出　　处：《中华医院感染学杂志》2016年第13期2994-2996,共3页Chinese Journal of Nosocomiology

基　　金：河北省科研基金资助项目([2014]101-141463183)

摘　　要：目的调查肺结核患者肺部感染病原菌分布与对常用抗菌药物的耐药性,为临床选择适宜抗感染药物提供依据。方法回顾性分析2013年1月-2015年8月就诊于医院157例肺结核合并肺部感染患者的临床资料,采用VITEK-32全自动微生物鉴定分析系统及配套试剂进行病原菌鉴定,采用K-B纸片扩散法进行药敏试验。结果共分离出182株病原菌,其中革兰阴性菌111株占61.0%,革兰阳性菌64株占35.2%,真菌7株占3.8%;铜绿假单胞菌对氨苄西林和庆大霉素耐药率均为100.0%,对头孢他啶、头孢哌酮、头孢吡肟等药物的耐药率均>50.0%;肺炎克雷伯菌对对头孢他啶、头孢哌酮等药物的耐药率均>50.0%;肺炎链球菌对青霉素G、左氧氟沙星、环丙沙星等药物的耐药率均>50.0%;金黄色葡萄球菌对青霉素G耐药率为100.0%,对红霉素、庆大霉素、四环素等药物的耐药率均≥50.0%。结论肺结核患者肺部感染的病原菌以革兰阴性菌为主,感染病原菌对多种药物具有较高的耐药性,临床治疗应参考药敏试验结果合理选择抗菌药物。OBJECTIVE To investigate the distribution of pathogens causing pulmonary infections in tuberculosis patients and analyze the drug resistance to commonly used antibiotics so as to provide guidance for reasonable use of antibiotics for treatment of the infections.METHODS The clinical data of 157 tuberculosis patients complicated with pulmonary infections who were treated in the hospital from Jan 2013 to Aug 2015 were retrospectively analyzed,the pathogens were identified by using VITEK-32 automatic microorganism identification analysis system and supporting reagents,and the drug susceptibility testing was performed with the use of K-B disk diffusion method.RESULTS A total of 182 strains of pathogens were isolated,including 111（61.0%）strains of gram-negative bacteria,64（35.2%）strains of gram-positive bacteria,and 7（3.8%）strains of fungi.The drug resistance rates of the Pseudomonas aeruginosa to ampicillin and gentamicin were 100.00%;the drug resistance rates to ceftazidime,cefoperazone,and cefepime were more than 50.0%.The drug resistance rates of the Klebsiella pneumoniae to ceftazidime and cefoperazone were more than 50.0%.The drug resistance rates of the Streptococcus pneumoniae to penicillin G,levofloxacin,and ciprofloxacin were more than 50.0%.The drug resistance rate of the Staphylococcus aureus to penicillin G was 100.0%;the drug resistance rates to erythromycin,gentamicin,and tetracycline were no less than 50.0%.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the pulmonary infections in the tuberculosis patients;the pathogens causing the infections are highly resistant to a variety of antibiotics.It is necessary for the hospital to reasonably use antibiotics based on the results of the drug susceptibility testing.

关 键 词：肺结核 肺部感染 病原菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]