艾滋病患者肺部感染病原和耐药情况分析

Pathogens and drug resistance of pulmonary infection in AIDS patients

目的 了解我国AIDS患者肺部感染的病原体分布及耐药情况。方法 分析116例AIDS患者经纤维支气管镜病原学和（或）病理学确诊的肺部感染的病原体及药物敏感试验结果。结果肺部单一病原感染18例（15．5％），多重感染98例（84．5％）。病原体分布：细菌91例，真菌62例，结核分枝杆菌49例，肺孢子菌29例，巨细胞病毒11例。共分离出细菌95株，以链球菌属（34株）、凝固酶阴性葡萄球菌（20株）、肺炎克雷伯杆菌（10株）及大肠埃希菌（7株）为主，存在对β-内酰胺类、大环内酯类、喹诺酮类和氨基糖苷类药物多重耐药，耐甲氧西林葡萄球菌14株，产超广谱β-内酰胺酶菌12株。分离出真菌68株，包括假丝酵母菌36株，青霉菌19株，曲霉菌6株，毛霉菌5株及其他2株，对两性霉素B敏感，对氟康唑耐药率5．6％～50．0％，对伊曲康唑耐药率10．5％～60．0％。结论本组AIDS患者肺部感染常同时存在多种病原，以细菌与真菌为主，呈现多重耐药现象，应根据药敏试验选择抗菌药物。

Objective To study the pathogens and drug resistance profiles of pulmonary infection in patients with AIDS. Methods The pathogens and their drug susceptibility of pulmonary infection diagnosed by fibrobronchoscopy-induced bronchoalveolar lavage fluid （BALF） culture and/or transbronehial biopsy in 116 AIDS cases were analyzed. Results Monopathogenic infection in lungs were detected in 18 cases （15.5%） and mixed infection in 98 cases （84. 5% ）. Of the 116 cases, bacteria were present in 91 patients, fungi in 62, tubercle bacillus in 49, pneumocystis jiroveci in 29, and eytomegalovirus in 11. Ninety-five bacterial strains were isolated from BALF, mainly including Streptococci （34）, eoagulase negative Staphylococcus （20） , Klebsiella pneumoniae （ 10 ） and Escherichia （7）. The isolated bacteria were resistant to β-lactam, macrolides, quinolones and aminoglycosides, of which were 14 methicillin-resistant Streptococci （MRS） strains and 12 extended spectrum β-lactamases （ESBI.） strains. Sixty-eight fungal strains were isolated, including 36 Candida mycodermas, 19 Penicilliums, 6 Aspergilli and 5 Mold fungi; they were sensitive to amphotericin B but resistant to fluconazol （5.6% -50. 0% ） and itraconazole （10. 5% -60. 0% ）. Conclusion Pneumonia in AIDS patients are usually caused by multiple pathogens, predominantly consisting of multiresistant bacteria and fungi. Therefore, antibiotics should be rationally chosen according to drug susceptibility test.