老年肺结核患者肺部感染的病原菌分布特点及耐药性分析  

Distribution of pathogens and drug resistance of pulmonary infection in elderly patients with pulmonary tuberculosis

作　　者：宁洪叶 蒋贤高 施伎蝉 何贵清 吴正兴 NING Hongye;JIANG Xiangao;SHI Jichan;HE Guiqing;WU Zhengxing(Department of Infectious Diseases,Wenzhou Central Hospital in Zhejiang Province,Wenzhou 325000,China)

机构地区：[1]浙江省温州市中心医院感染科,浙江温州325000

出　　处：《中国现代医生》2018年第27期78-80,共3页China Modern Doctor

基　　金：浙江省温州市第二期科技计划项目(Y20130296)

摘　　要：目的观察分析老年肺结核患者肺部感染的病原菌分布特点及耐药性。方法选取2016年10月～2017年10月本院收治的163例肺结核肺部感染老年患者作为研究对象,留取163例痰液标本,进行药敏试验分析。结果163例痰液标本中共分离出200例病原菌,其中123例革兰阴性菌、59例革兰阳性菌、18例真菌;铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶产生的耐药率最高,其次为氨苄西林,最后为亚胺培南;肺炎克雷伯菌氨苄西林产生的耐药率最高,其次为磺胺甲噁唑/甲氧苄啶,最后为亚胺培南;大肠埃希菌对氨苄西林产生的耐药率最高,其次为左氧沙星,最后为亚胺培南;鲍氏不动杆菌对氨苄西林产生的耐药率最高,其次为磺胺甲噁唑/甲氧苄啶,最后为亚胺培南;金黄色葡萄球菌、肺炎链球菌、溶血葡萄球菌等革兰阳性菌对青霉素所产生的耐药率均较高,对万古霉素产生的耐药率均较低;白色念珠菌、光滑念珠菌和热带念珠菌等真菌对氟胞嘧啶、氟康唑等抗菌药物的耐药率均为0。结论老年肺结核患者肺部感染的主要致病菌为革兰阴性菌,临床应该根据药敏试验结果合理选择相关抗菌药物再加以针对性治疗。.Objective To observe and analyze the pathogenic bacteria distribution and drug resistance of pulmonary in- fection in elderly pulmonary tuberculosis patients. Methods A total of 163 elderly patients with pulmonary irlfeetion by pulmonary tuberculosis who were admitted in our hospital from October 2016 to October 2017 were selected as study subjects, and 163 sputum specimens were taken for drug susceptibility testing. Results A total of 200 pathogens were isolated from 163 sputum specimens, including 123 gram-negative bacteria, 59 gram-positive bacteria, and 18 fungi. Pseudomonas aeruginosa had the highest resistance rate to sulfamethoxazole/trimethoprim, followed by ampicillin and fi- nally imipenem. Klebsiellapneumoniae had the highest resistance rate to ampicillin, followed by sulfamethoxazole/ trimethoprim and finally imipenem. Escherichia coli had the highest resistance rate to ampicillin, followed by lev- ofloxacin, and finally imipenem. Acinetobacterbaumannii had the highest resistance rate to ampicillin, followed by sul- famethoxazole/trimethoprim and finally imipenem.The resistance rate of gram-positive bacteria such as Staphylococcus aureus, Streptococcus pneumoniae and Staphylococcus haemolyticus to penicillin was relatively high and the drug resis- tance rate to vancomycinwas relatively low. The resistance rates offungicides such as candida albicans, candida glabrata and candida tropicalis were 0 to flucytosine, fluconazole. Conclusion The main pathogenic bacteria of pulmonary infection in elderly tuberculosis patients are gram-negative bacteria. Relevant antimicrobial agents should be selected based on drug sensitivity test results and then targeted treatment is to be performed in clinical.

关 键 词：老年肺结核患者 肺部感染 病原菌分布特点 耐药性 

分 类 号：R521[医药卫生—内科学] R563.1[医药卫生—临床医学]