艾滋病合并败血症的临床特征与病原菌及耐药性分析  

Analysis on the clinical characteristics, distribution and drug resistance of pathogens in the patients with acquired immunodeficiency syndrome complicated with sepsis

作　　者：高慧[1] 施理[1] 林锋[1] 肖芙蓉[1] 吴彪[1] 张秀春[1] 王姣[1] 吴涛[1] GAO Hui;SHI Li;LIN Feng;XIAO Fu-rong;WU Biao;ZHANG Xiu-chun;WANG Jiao;WU Tao(Hainan People's Hospital,Haikou,Hainan 570125,China)

机构地区：[1]海南省人民医院感染科

出　　处：《中华医院感染学杂志》2019年第23期3544-3547,3572,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81260264)

摘　　要：目的分析获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)合并败血症患者的临床特征、病原菌分布及耐药性,为临床诊断和治疗工作提供研究依据。方法选取2012年1月-2018年11月某医院收治的50例AIDS合并败血症患者作为研究组,选取同期未合并败血症的50例AIDS患者作为对照组,对两组患者的临床特征及研究组患者血液样本的病原菌分布、耐药性进行回顾性分析。结果研究组患者的年龄、确诊感染时间、红细胞计数、血红蛋白水平高于对照组,出现发热、肺部渗出病灶的患者比例高于对照组(P<0.05)。共分离出65株病原菌,其中,革兰阳性菌26株占40.00%,革兰阴性菌22株占33.85%,分枝杆菌3株占4.62%,真菌14株占21.54%,以马尔尼菲蓝状菌和新型隐球菌为主。主要革兰阳性菌对青霉素G、磺胺甲噁唑/甲氧苄啶、苯唑西林、红霉素、环丙沙星、左氧氟沙星的耐药菌株较多,对替加环素、呋喃妥因、喹奴普汀/达福普汀的耐药菌株较少,未检出对万古霉素或利奈唑胺耐药的菌株。主要革兰阴性菌对氨苄西林、头孢唑林、庆大霉素、磺胺甲噁唑/甲氧苄啶的耐药菌株较多,对亚胺培南、厄他培南、阿米卡星、哌拉西林/他唑巴坦的耐药菌株较少。结论AIDS合并败血症患者具有年龄大、病程长、营养水平低等特点,及发热、肺部感染、白细胞升高的临床表现显著特征,病原菌以葡萄菌属、肠杆菌、沙门菌属及真菌为主,分枝杆菌感染也是重要的感染类型,这些病原菌对常用抗菌药物的耐药性均较高,临床医生应提高早期诊断效率并选取敏感性药物进行治疗。OBJECTIVE To analyze the clinical characteristics,distribution and drug resistance of pathogens in the patients with acquired immunodeficiency syndrome(AIDS)complicated with sepsis,so as to provide research basis for clinical diagnosis and treatments.METHODS Totally 50 patients with AIDS complicated with sepsis were selected as the study group from Jan.2012 to Nov.2018,and 50 patients with AIDS without sepsis during the same period were selected as the control group.The clinical characteristics of the patients in both groups,the distribution and the drug resistance of the pathogens in the blood samples of the patients in the study group were retrospectively analyzed.RESULTS The age,the duration of infection,the red blood cells counts and the hemoglobin level of the patients in the study group were significantly higher than those in the control group.The proportions of the patients with fever and pulmonary exudation were significantly higher than those in the control group(P<0.05).A total of 65 strains of pathogens were isolated,in which,26 strains were Gram-positive bacteria accounting for 40.00%,22 strains were Gram-negative bacteria accounting for 33.85%,3 strains were Mycobacterium accounting for 4.62%,and 14 strains were fungi accounting for 21.54%.The major pathogens were Brucella marneffei and Cryptococcus neoforman.The main Gram-positive bacteria were more resistant to penicillin G,sulfamethoxazole/trimethoprim,oxacillin,erythromycin,ciprofloxacin and levofloxacin,and less resistant to tegacycline,furantoin,quinopristine/dafoputin.No strains resistant to vancomycin or linezolid were detected.The main Gram-negative bacteria were more resistant to ampicillin,cefazolin,gentamicin,sulfamethoxazole/trimethoprim,and less resistant to imipenem,ertapenem,amikacin,and piperacillin/tazobactam.CONCLUSION The patients with AIDS complicated with sepsis have significant clinical characteristics such as senile age,longer duration,lower nutritional level and significant manifestations of fever,pulmonary infection and leuk

关 键 词：获得性免疫缺陷综合征 败血症 临床特征 病原菌 耐药性 

分 类 号：R512.91[医药卫生—内科学]