肺结核并发呼吸机相关性肺炎病原菌特点及临床分析

Analysis of ventilator-associated pneumonia occurring in patients with pulmonary tuberculosis

目的了解肺结核患者呼吸机相关性肺炎(VAP)病原菌菌谱构成和药敏情况,为临床经验性治疗提供参考。方法选择2007年1月至2011年1月入住重症监护病房(ICU)接受机械通气治疗,确诊为VAP的58例患者,采用一次性呼吸道吸引导管Ⅱ型或纤维支气管镜直接经气管插管或气管切开套管留取患者深部痰标本,镜检合格标本接种至培养基分离培养,普通细菌培养基采用血琼脂和麦康凯琼脂,真菌培养采用沙保罗培养基,培养后采用VITEK32全自动微生物分析仪进行细菌鉴定和药敏试验。分析并发VAP的肺结核患者的临床特点、病原菌分布、耐药情况和治疗结果。结果58例发生VAP肺结核患者共分离104株病原菌,其中革兰阴性(G-)杆菌71株[占68.3%(71/104)]、革兰阳性(G+)球菌8株[占7.7%(8/104)]、真菌25株[占24.0%(25/104)]。肺结核并发VAP的主要病原菌为鲍曼不动杆菌[占26.0%(27/104)]、铜绿假单胞菌[占21.2%(22/104)]、白色念珠菌[占14.4%(15/104)]。2种及2种以上病原菌混合感染患者26例[占44.8%(26/58)]。结论肺结核并发VAP的主要病原菌为G-杆菌和真菌,混合感染率较高。

Objective To analyze the clinical characteristics of pathogens spectrum of ventilator-associated pneumonia（VAP） occurring in patients with pulmonary tuberculosis in the intensive care unit（ICU） and to provide a clinical strategy of using antibacterial agents.Methods Fifty-eight pulmonary tuberculosis patients with VAP from January 2007 to January 2011 were retrospectively analyzed in clinical features,bacterial culture of sputum and results of drug sensitiveness test.Results One hundred and four bacterial strains were isolated in the sputum from the 58 pulmonary tuberculosis patients with VAP,which gram-negative bacilli,gram-positive cocci,and fungi accounted for 68.3%（71/104）,7.7%（8/104）and 24.0%（25/104）,respectively.The major pathogens were acinetobacter baumannii（26.0%,27/104）,pseudomonas aeruginosa（21.2%,22/104） and candida albicans（14.4%,15/104）.Twenty-six cases（44.8%,26/58） had co-infections with at least 2 kinds of pathogens.Conclusion The main pathogens in VAP with pulmonary tuberculosis are gram-negative bacilli and fungi,mixed infection is high.