肺结核患者肺部感染病原菌耐药性分析与预防研究

Pathogenic characteristics and drug resistance analysis of pulmonaryinfection in patients with pulmonary tuberculosis

目的探讨分析肺结核患者合并肺部感染的病原菌特点、耐药性情况及预防意义。方法选取2017年10月至2018年10月杭州市富阳区第一人民医院收治的322例肺结核合并肺部感染患者,采集患者痰样本,对病原菌进行鉴定,分析感染患者的病原菌特点及耐药性。结果322例患者的痰样本分离出病原菌379株,其中革兰阳性菌89株(23.48%),以金黄色葡萄球菌为主;革兰阴性菌241株(63.59%),以肺炎克雷伯菌为主,其次是铜绿假单胞菌和大肠埃希菌;真菌49株(12.93%),以白假丝酵母菌为主。革兰阳性菌对万古霉素高度敏感,耐药率均为0%,对氨苄西林/舒巴坦、青霉素、阿奇霉素等常用抗菌药物具有较强的耐药性;革兰阴性菌对美罗培南、亚胺培南等抗菌药物高度敏感,耐药率均为0%,对头孢西丁、哌拉西林、氨苄西林等常用抗菌药物具有较强的耐药性;真菌对两性霉素高度敏感,耐药率为0%,对伏立康唑、伊曲康唑等有较强的耐药性。结论肺结核患者肺部感染病原菌分布较广,对多数常用抗菌药物具有高度耐药性,增加了临床治疗难度,因此临床上应加强对肺结核患者预防干预措施,以减少患者肺部感染的发生率,对已经感染的患者应根据药敏试验结果针对性的选择合适的抗菌药物进行治疗。

Objective To understand the etiological characteristics of pulmonary bacterial infection in patients with pulmonary tuberculosis,and to analyze the drug resistance of pathogens.Methods 322TB patients with pulmonary infection admitted to the First People′s Hospital of Fuyang district in Hangzhou City from October 2017to October 2018were selected.Sputum samples were collected to isolate and identify the pathogenic bacteria,the drug resistances of pathogens were analyzed as well.Results A total of 379strains of pathogenic bacteria were isolated from sputum samples of 322patients,of which 89were Gram-positive bacteria,accounting for 23.48%,241strains were Gram-negative bacteria,accounted for 63.59%and 49strains were fungi,accounted for 12.93%.Staphylococcus aureus,Klebsiella pneumonia and Candida albicans were predominant pathogens of Gram-positive,Gram-negative and fungi,respectively.Gram-positive.bacteria were highly sensitive to vancomycin with 0%resistance rate,while they were highly resistant to ampicillin/sulbactam,penicillin,azithromycin and other commonly used antibiotics.Gram-negative bacteria were highly sensitive to meropenem,imipenem and other antibiotics with 0%resistance rate,while they were resistant to cefoxitin and piperacillin.Fungi were highly sensitive to amphotericin with 0%resistance rate,while they were highly resistant to voriconazole,ketoconazole and other commonly used antibiotics.Conclusions The distribution of pathogenic bacteria in TB patients with pulmonary infection is complex,and they are highly resistant to most commonly used antibiotics,which elevates the difficulty of clinical treatment.Therefore,prevention and intervention measures should be strengthened in order to reduce the incidence of pulmonary bacterial infection.For TB patients with pulmonary bacterial infection,drug sensitivity test should be performed to select appropriate antibiotics.