非结核性胸膜炎和脓胸患者的临床特征及病原特点分析  

Clinical features and etiological characteristics of the non-tuberculous pleurisy and empyema patients

作　　者：钱雪峰[1] 宋晓超 金美娟[1] 吴琛[1] 赵瑶[1] 刘明星[1] 韩如慧 乔美珍[1] QIAN Xue-feng;SONG Xiao-chao;JIN Mei-juan;WU Chen;ZHAO Yao;LIU Ming-xing;HAN Ru-hui;QIAO Mei-zhen(The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China)

机构地区：[1]苏州大学附属第一医院感染管理处,江苏苏州215006

出　　处：《中华医院感染学杂志》2018年第8期1199-1202,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81702044)

摘　　要：目的分析非结核性胸膜炎和脓胸患者的临床特征、病原谱及药物敏感性特点。方法回顾分析2007年9月-2017年9月医院收治的非结核性胸膜炎和脓胸的患者病例资料,并检测病原菌分布及对抗菌药物敏感性。结果 10年间共收集非结核性胸膜炎和脓胸患者159例,其中51例为经淋巴途径播散的纵膈脓肿、肝脓肿和经血液播散的败血症、脓毒症引起,108例为解剖屏障破坏所致;共分离病原菌187株,革兰阴性菌占37.4%(70株),其中铜绿假单胞菌所占比例最高(13.9%,26株),肠杆菌科细菌其次(11.8%,22株);革兰阳性菌占47.1%(88株),其中凝固酶阴性葡萄球菌所占比例最高(23.0%,43株),屎肠球菌其次(11.8%,22株);真菌占11.2%(21株);体外药敏试验显示,葡萄球菌对青霉素G和甲氧西林耐药率高;肠杆菌科细菌耐药情况相对严重,16种常用代表性抗菌药物中仅头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、丁胺卡那和亚胺培南敏感性较高,铜绿假单胞菌多重耐药占比高。159例非结核性胸膜炎和脓胸患者中,137例治愈出院,占86.2%。结论解剖屏障破坏为非结核性胸膜炎和脓胸的主要病因,病原菌主要为口咽部、呼吸道正常菌群、定植菌群和人工气道开放后侵入的环境菌,病原菌中非发酵菌对常用抗菌药物敏感性低,真菌性胸膜炎和脓胸数量有逐年增高的趋势,早诊断早治疗困难,患者预后差。OBJECTIVE To investigate the clinical features, pathogenic spectrums of the non-tuberculous pleurisy and empyema patients and analyze the drug susceptibility.METHODS The clinical data of the non-tuberculous pleu- risy and empyema patients who were treated in the hospital from Sep 2007 to Sep 2017 were retrospectively ana- lyzed. The distribution and drug susceptibility rates of the pathogens were observed.RESULTS A total of 159 non- tuberculous pleurisy and empyema patients were collected during the 10 years, 51 of whom had the non-tubercu- lous pleurisy and empyema that was caused by mediastinal abscess and hepatic abscess spread through the lym- phatic pathway as well as sepsis spread through blood, and 108 had the non-tuberculous pleurisy and empyema that was caused by the damage of anatomical barrier. Totally 187 strains of pathogens were isolated, 70 （37.4%0） of which were gram-negative bacteria, 88 （47.1%） were gram-positive bacteria, and 21 （11.2%） were fungi; Pseudomonas aeruginosa （13.9%, 26 strains） was the predominant species of the gram-negative bacteria, fol- lowed by Enterobacteriaceae （11.8%, 22 strains）; the proportion of coagulase-negative Staphylococcus （23.0%, 43 strains） was the highest among the gram-positive bacteria, followed the proportion of Enterococcus faeciurn （11.8 %, 22 strains）. The in vitro drug susceptibility testing indicated that the drug resistance rates of the Staph- ylococcus strains to peniciLLin G and methicillin were high, the Enterobacteriaceae strains were highly drug-resist- ant; among the 16 types of commonly used antibiotics, the strains were highly susceptible to eefoperazone-sulbac- tam, piperaeillin-tazobaetam, amikacin and imipenem; the proportion of the muhidrug-resistant Pseudomonas aeruginosa was high. Of the 159 non-tuberculous pleurisy and empyema patients, 137 were cured and discharged, accounting for 86.2%.CONCLUSION The damage of anatomical barrier is the leading cause of the non-tuberculous pleurisy and empyema. The normal flor

关 键 词：解剖屏障 非结核性胸膜炎 脓胸 病原菌 药物敏感性 

分 类 号：R378[医药卫生—病原生物学]