耐多药肺结核患者呼吸道感染的病原菌分布及药敏分析

Distribution and drug susceptibility of pathogens causing respiratory tract infections in multidrug-resistant pulmonary tuberculosis patients

目的了解耐多药肺结核呼吸道感染患者的病原菌分布及药敏性,为临床合理用药提供参考依据。方法随机选择2011年2月-2013年7月结核科住院耐多药肺结核呼吸道感染痰培养阳性患者68例作为观察组,选择同期住院的肺结核呼吸道感染痰培养阳性患者120例作为对照组,进行痰培养及药敏试验,比较两组患者的病原菌分布及药敏性,采用SPSS13.0统计软件对数据进行分析,两组数据组间比较采用χ2检验。结果观察组68例患者送检标本共检出病原菌133株,其中革兰阴性菌87株占65.41%,前3位依次为肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌,分别占26.32%、12.03%、7.51%,其次是真菌44株占33.08%,主要以白色假丝酵母菌为主、29株占21.80%,革兰阳性菌检出2株占1.50%;对照组检出病原菌402株,其中革兰阴性菌263株占65.42%,真菌97株占24.13%,革兰阳性菌42株占10.45%,两组肺结核患者均以革兰阴性杆菌感染为主,但菌株构成不同,观察组肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌的检出率明显高于对照组,副流感嗜血菌检出率则明显低于对照组,真菌检出率高于对照组,革兰阳性菌检出率略低于对照组,两组比较差异均有统计学意义(P<0.05);观察组革兰阴性杆菌对第三代喹诺酮类、碳青霉烯类和头孢菌素等抗菌药物的耐药性增高(P<0.05);革兰阴性球菌对万古霉素较为敏感,对克林霉素、青霉素耐药率较高。结论耐多药肺结核呼吸道感染患者的病原菌以革兰阴性杆菌感染为主,其耐药性高,临床应减少不合理用药,避免因抗菌药物滥用引起的混合感染。

OBJECTIVE To understand the distribution and drug susceptibility of pathogens causing respiratory tract infections in multidrug-resistant pulmonary tuberculosis patients so as to provide guidance for reasonable clinical use of antibiotics. METHODS Totally 68 cases of multidrug-resistant pulmonary tuberculosis patients complicated with respiratory tract infections with sputum cultured positive, who were hospitalized from Feb 2011 to Jul 2013, were randomly selected as the observation group, meanwhile, 120 cases of pulmonary tuberculosis patients complicated with respiratory tract infections, the sputum specimens from whom were cultured positive, were chosen as the control group, then the sputum culture and the drug susceptibility testing were performed, the distribution and the drug susceptibility of the pathogens were observed and compared between the two groups, the data were statistically analyzed with the use of SPSS13.0 software, and the chi-square test was performed for the comparison of the data between the two groups. RESULTS In the observation group, totally 133 strains of pathogens have been isolated from the submitted specimens from the 68 patients, including 87 （65.41%） strains of gram-negative bacilli, 44 （33. 08%） strains of fungi, and 2 （1. 50%） strains of gram-positive cocci~ the Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae ranked the top three species of gram-negative bacilli, accounting for 26.32%, 12.03%, and 7.51%, respectively~ the Candida albican （29 strains ） was the predominant species of fungi, accounting for 21.80%. In the control group, totally 402 strains of pathogens have been isolated, including 263（65.42~） strains of gram-negative bacteria, 97 （24.13%） strains of fungi, and 42（10.45~//00） strains of gram-positive bacteria. Among the tuberculosis patients in both groups, the gram-negative bacilli were the predominant pathogens causing infections and varied in the constituent ratio. The isolation rate of the K. pneumoniae, E. coli, or E. cloacae of the observation group was significantly higher than that of the control group, while the isolation rate of Haemophilus influenzae of the observation group was significantly lower than that of the control group, the isolation rate of the fungi of the observation group was higher than that of the control group, and the isolation rate of the gram-positive bacteria of the observation group was slightly lower than that of the control group（P^0.05） ~ the drug resistance rates of the gram-negative bacilli to the third-generation quinolones, carbapenems, and cephalosporins were increased （P~ 0. 05）; the gram-negative cocci were highly susceptible to vaneomycin, and the drug resistance rates to clindamycin and penicillin were high. CONCLUSION The gram-negative bacilli are dominant among the pathogens causing respiratory tract infections in the patients with multidrug-resistant tuberculosis, of which the drug resistance rates are high~ it is necessary for the hospital to reduce the unreasonable medication and avoid the abuse of antibiotics so as to prevent mixed infections.