肺结核患者呼吸道感染病原菌分布及耐药性研究  

Distribution and drug resistance of pathogens causing respiratory tract infections in patients with tuberculosis

作　　者：罗宣萍[1] 程永素 黄冰 徐敏[3] 古丽玲 LUO Xuan-ping , CHENG Yong-su, HUANG Bing, XU Min, GU Li-ling(C, uizhou Center for Disease Control and Prevention, Cruiyang, Guizhou 550004, Chin)

机构地区：[1]贵州省疾病预防控制中心门诊部,贵州贵阳550004 [2]贵州医科大学附属医院院感科,贵州贵阳550004 [3]贵州省人民医院康复医学科,贵州贵阳550002

出　　处：《中华医院感染学杂志》2018年第6期859-862,共4页Chinese Journal of Nosocomiology

基　　金：贵州省卫生计生委科技基金资助项目(GZWJKJ2015-1-021)

摘　　要：目的探讨肺结核并发感染的致病菌与耐药性。方法选取2014年3月-2017年3月收治的119例肺结核患者为研究对象,分析其呼吸道感染率,并检测感染病原菌构成及药物敏感性。结果 119例肺结核患者中并发呼吸道感染67例,感染率为56.30%;67例感染患者共检出病原菌96株,其中革兰阴性菌62株,占64.58%,以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌26株,占27.08%,以金黄色葡萄球菌、表皮葡萄球菌为主,真菌8株,占8.34%;铜绿假单胞菌对头孢吡肟、头孢哌酮、亚胺培南、美罗培南和氨曲南耐药率低;大肠埃希菌对阿米卡星、头孢吡肟、头孢哌酮和哌拉西林耐药率低;肺炎克雷伯菌对阿米卡星、头孢哌酮、亚胺培南、美罗培南耐药率低;金黄色葡萄球菌对利奈唑胺、红霉素、万古霉素、磺胺甲唑/甲氧苄啶和替加环素耐药率低;表皮葡萄球菌对万古霉素、红霉素、呋喃妥因和磺胺甲唑/甲氧苄啶耐药率低;白假丝酵母和热带假丝酵母均对两性霉素B耐药率为0。结论肺结核患者继发呼吸道感染主要以革兰阴性菌导致的机会性感染为主,呈高耐药、多药耐药特性,临床治疗时应该早行药敏试验指导合理选择抗菌药物治疗。OBJECTIVE To explore the distribution and drug resistance of pathogens causing infections in patients with tuberculosis.METHODS A total of 119 patients with tuberculosis who were treated from Mar 2014 to Mar 2014 were recruited as the study objects,the incidence of respiratory tract infections was analyzed,and the constituent ratios of the pathogens causing the infections and the drug susceptibility rates were observed.RESULTS Of the 119 patients with tuberculosis,67 were complicated with respiratory tract infections,with the infection rate 56.30%.Totally 96 strains of pathogens were isolated from the 67 patients with the infections,62（64.58%）of which were gram-negative bacteria,26（27.08%）were gran-positive bacteria,and 8（8.34%）were fungi;Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae were dominant among the gram-negative bacteria;Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria.The drug resistance rates of the P.aeruginosastrains to cefepime,cefoperazone,imipenem,meropenem and aztreonam were low;the drug resistance rates of the K.pneumoniae strains to amikacin,cefoperazone,imipenem and meropenem were low;the drug resistance rates of the S.aureus strains to linezolid,erythromycin,vancomycin,sulfamethoxazole-trimethoprim and tigecycline were low;the drug resistance rates of the S.epidermidis strains to vancomycin,erythromycin,nitrofurantoin and sulfamethoxazole-trimethoprim were low;the drug resistance rates of Candida albicans and Candida tropicalis to amphotericin B were 0%.CONCLUSIONThe patients with opportunistic infections caused by the gram-negative bacteria are dominant among the tuberculosis patients with secondary respiratory tract infection and are characterized by high drug resistance and multi-drug resistance.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 感染 病原菌 耐药 

分 类 号：R563.1[医药卫生—呼吸系统]