763例肺结核患者下呼吸道病原菌分布及耐药性分析

The Bacterial Strains′distribution and Antimicrobial Susceptibility Analysis of 847 Cases of Tuberculosis Accompanied with Lower Respiratory Infection

目的分析肺结核合并下呼吸道感染的菌种分布及耐药情况,为临床合理使用抗生素提供依据。方法统计安徽省胸科医院2011年度肺结核合并下呼吸道感染763例痰标本的培养和药敏实验结果。结果 3 881份痰标本共检测出763株菌株,其中革兰阴性菌447株(58.59%)、革兰阳性菌154株(20.18%)和真菌162株(21.23%)。主要病原菌依次为肺炎克雷伯菌、白色假丝酵母菌、鲍曼不动杆菌和铜绿假单胞菌。不论是革兰阴性杆菌还是革兰阳性球菌均表现出极高的多耐药性,革兰阴性杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率较低,金黄色葡萄球菌对万古霉素未出现耐药现象。结论下呼吸道分离病原菌耐药现象普遍存在,临床应重视病原学检查,开展病原菌耐药性监测,合理使用抗菌药物。

Objective To analyse the strains＇ distribution and drug resistance of tuberculosis accompanied with lower respiratory infection, and provide a reasonable basis for the clinical use of antibiotics. Methods The pathogens sputum culture results were reviewed and analyzed on 763 cases of tuberculosis patients in Anhui Chest Hospital. Results Totally 763 bacteria were found in secretion of 3 881 patients. Gram negative bacilli accounted for 58.59% ,gram-positive cocci accounted for 20. 18%, and fungi accounted for 21. 23%. Klebsiella pneumoniae, Acinetobader baumannii, Pseudomonas aeruginosa, E. cloacae, Candida albieans were the main bacteria. Drug resistances were common in Gram-negative bacilli （GNB） and Gram-positive cocci（GPC）. Piperacillin/tazobactam and eefoperazone/sulbaetam and imipenem were the most sensitive for GNB. Staphyloccocus aureus was sensitive to vancomycin. Conclusion Drugresistance of the pathogenicbacteria in lower respiratory tract infection is common and it is of great importance to emphasize pathogenic bacterium monitoring,so as to use the antibacterials exactly.