住院肺结核患者下呼吸道感染病原菌分布及药物敏感性分析

Analysis on pathogenic bacteria distribution and antimicrobial susceptibility of patients on concurrent lower respiratory tract infection in patients with pulmonary tuberculosis

目的了解肺结核合并下呼吸道感染患者痰培养病原菌构成、变化及药敏试验结果。方法对天津市海河医院2008、2009年肺结核合并下呼吸道感染住院患者送检的合格痰标本进行细菌培养,对阳性结果做体外药敏试验。结果共获得病原体844株,以革兰阴性菌为主,共434株,革兰阳性菌118株,真菌292株,分别占51.4%、14.0%、34.6%。革兰阴性菌中以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主。革兰阳性菌中以葡萄球菌为主。真菌感染率有上升趋势。老年结核患者、复治患者、近3个月有除结核药之外抗生素使用史患者更容易合并革兰阴性菌及混合感染。对革兰阴性菌敏感率高的抗生素是头孢吡肟、哌拉西林他唑巴坦、氨基糖苷类、亚胺培南等。对革兰阳性菌敏感率较高的抗生素是万古霉素及利奈唑胺。结论肺结核合并下呼吸道感染患者痰培养病原菌主要为革兰阴性菌,治疗最好及时进行痰细菌培养,明确病原针对性用药。在未明确感染致病菌前,可选用对革兰阴性菌效果较好的抗生素,同时兼顾革兰阳性菌感染的可能。

Objective To investigate the characteristics of the distribution,change and drug susceptibility of pathogenic bacteria in lower respiratory tract of pulmonary tuberculosis patients.Methods Collecting pathogens of respiratory tract samples from 2008 to 2009 of Tianjin Haihe Hospital were cultured,the drug resistance was tested.Results A total of 844 pathogens were found,among which 434 strains were gram-negative bacilli（51.4%）,118 strains were gram-positive cocci（14.0%）,292 strains were fungi（34.6%）.The primer gram-negative bacilli were Klebsiella pneumonia,Pseudomonas aeruginosa,Escherichia coli.Most of gram-positive cocci were Staphylococcus.The proportion of fungi was at rise.Senile pulmonary tuberculosis,repeatedly treated pulmonary tuberculosis,the past three months of antibiotics used except anti-tuberculosis drug in the history tuberculosis patients were easier to infect gram-negative bacilli and mixed infection.Most of the gram-negative bacteria were highly sensitive to cefepime,tazobactam＋piperacillin,aminoglycoside antibiotics,imipenem et al.The primary gram-positive bacteria were vancomycin and linezolid.Conclusion The primary pathogenic bacteria were gram-negative bacteria in lower respiratory tract of the patients with pulmonary tuberculosis.It is necessary to pay more attention to the detection of etiology.Strengthening the surveillance of antimicrobial resistance and understanding the spectrum of bacterial resistance can effectively guide the clinical treatments.