肺结核患者合并肺部感染的病原菌分布及耐药性分析

Distribution and drug resistance analysis of pathogenic bacteria in pulmonary tuberculosis patients complicated with pulmonary infection

目的探讨肺结核患者合并肺部感染的病原菌分布特点及耐药性,为临床合理用药和控制医院内感染提供依据。方法对2009年1月至2011年12月该院肺结核患者合并肺部感染时下呼吸道标本中分离出的阳性标本进行病原菌及耐药性分析。结果分离病原菌510株,其中革兰阴性杆菌占65.88%,真菌占19.02%,革兰阳性球菌占15.10%。感染前5位病原菌为铜绿假单胞菌(18.04%)、肺炎克雷伯菌(11.96%)、鲍曼不动杆菌(11.18%)、金黄色葡萄球菌(10.39%)和白假丝酵母菌(10.00%)。革兰阴性杆菌对氨苄西林、头孢唑啉耐药率大于97.00%。铜绿假单胞菌对亚胺培南耐药率(15.22%)最低,鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率(21.05%)最低,肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌对亚胺培南全部敏感(100.00%),革兰阳性球菌对万古霉素敏感率为100.00%。结论革兰阴性杆菌、真菌是该院肺结核患者合并肺部感染的常见病原菌,多药耐药性较高,临床医生应根据药敏试验结果选择合理的抗菌药物。

Objective To investigate the distribution and drug resistance of pathogenic bacterial isolated from pulmonary tuberculosis patients complicated with pulmonary infection,and to guide rational usage of antibiotics and control nosocomial infection.Methods Samples of lower respiratory tract,collected from pulmonary tuberculosis patients complicated with pulmonary infection in this hospital during Jan.2009 and Dec.2011,were analyzed to investigate distribution and drug resistance of pathogenic bacteria.Results 510 strains of pathogens were isolated,among which 65.88% were Gram negative bacilli,10.00% were fungi and 15.09% were Gram positive cocci.The most five common pathogenic bacteria were Pseudomonas aeruginosa（18.11%）,Klebsiella pneumonia（13.39%）,Acinetobacter baumanni（11.18%）,Staphylococcus aureus（10.39%） and Candida albicans（10.00%）.The resistance rate of Gram negative bacilli to Ampicillin and Cefazolin was more than 97.30%,that of Pseudomonas aeruginosa to Imipenem and Meraopenem was lowest（15.22%）,that of Acinetobacter baumannii to Cefoperazone/Sulbactam was lowest（21.05%）.All strains of Klebsiella pneumonia,Enterobacter cloacae and Escherichia coli were sensitive to Imipenem（100.00%）,and all strains of Gram positive cocci were sensitive to Vancomycin（100.00%）.Conclusion Gram negative bacilli and fungi might be the common pathogens casing pulmonary tuberculosis complicated with pulmonary infection in this hospital,which might be with multi-drug resistance.Antibiotics should be rationally prescribed according to the results of drug susceptibility tests.