终末期肾脏病患者肺部感染病原菌分析

Pathogens causing pulmonary infections in patients with end-stage renal disease

目的探讨终末期肾脏病患者肺部感染的病原菌分布及耐药规律,指导临床经验性用药。方法对183例终末期肾脏病合并肺部感染患者的临床资料进行分析。结果 183例终末期肾脏病合并肺部感染患者痰液中分离出127株病原菌,其中革兰阴性菌90株占70.87%,革兰阳性菌21株占16.54%,真菌16株占12.59%;革兰阴性菌主要为铜绿假单胞菌20株占15.75%,大肠埃希菌16株占12.60%,肺炎克雷伯菌13株占10.24%,流感嗜血菌11株占8.66%;革兰阳性菌为金黄色葡萄球菌6株占4.72%;革兰阴性菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星耐药率较低;革兰阳性菌对万古霉素耐药率低,对呋喃妥因、哌拉西林/他唑巴坦、磺胺甲噁唑/甲氧苄啶的耐药率其次;病原菌对其他常用抗菌药物的耐药率均>50.00%;而各类细菌对哌拉西林/他唑巴坦的耐药率均<30.00%;伊曲康唑及氟康唑对真菌普遍有效。结论终末期肾脏病患者肺部感染的病原菌主要为革兰阴性菌,且病原菌对多种抗菌药物耐药明显;老年及糖尿病肾病患者肺部感染后,死亡率明显升高;一旦确诊应尽早行病原学检查,根据药物敏感试验结果选择有效抗菌药物。

OBJECTIVE To study the distribution and drug resistance of pathogens causing pulmonary infections in the patients with end-stage renal disease so as to guide the clinical medication. METHODS The clinical data of the end-stage renal disease patients complicated with pulmonary infections were retrospectively analyzed. RESULTS A total of 127 strains of pathogenic bacteria were isolated from the sputum of 183 end-stage renal disease patients complicated with pulmonary infections, among which there were 90 （70.87 %） strains of gram-negative bacteria, 21（16.54%） strains of gram-positive bacilli, and 16（12. 59%） strains of fungi. The 20 strains of Pseudomonas aeruginosa （15.75%）, 16 strains of Escherichia colt （12.60%）, 13 strains of KlebsieIla pneumoniae （10.2%）, and 11 strains of Hemophilies influenzae （8.66%） were the predominant species of gram-negative bacilli; the 6 strains of Staphylococcus aureus （4. 72~） were dominant in the gram-positive cocci. According to the drug susceptibility testing result, the drug resistance rates of the gram-negative bacilli to piperacillin/tazobactam, imi- penem, and amikaein were relatively low; the drug reistance rate of the gram-positive cocci to vancomycin was low, followed by piperaeillin/tazobactam, sulfamethoxazole/trimethoprim, and nitrofurantoinl the drug resistance rates of the pathogens to other common antibiotics were more than 50.00%, and the resistance rates of various types of bacteria to the piperacillin/tazobactam were less than 30.00%. Itraconazole and flueonazole were general- ly susceptible to the fungi. CONCLUSION The gram-negative bacteria are the predominant pathogens causing the pulmonary infections in the end-stage renal disease patients and are significantly resistant to multiple antibiotics; the mortality of the senile diabetes nephropathy patients complicated with pulmonary infections is significantly ele- vated; once diagnosed, it is necessary to conduct the etiological examination in a timely manner and to choose ef- fective antibiotics according to the drug susceptibility testing result.