肺结核合并非发酵菌下呼吸道感染的临床特征及耐药性分析

Clinical characteristics and drug-resistance of pulmonary tuberculosis complicated with lower respiratory tract infection by non-fermentative bacteria

目的了解肺结核患者合并非发酵菌下呼吸道感染的临床特征及耐药性,为临床合理使用抗菌药物提供依据。方法采用ATB全自动细菌鉴定仪,对临床分离菌株进行菌种鉴定,用K-B法对非发酵菌做药物敏感试验。结果从肺结核患者下呼吸道标本中共分离非发酵菌156株,其中铜绿假单胞菌最多,占46.5%,其次为鲍曼不动杆菌和嗜麦芽寡养单胞菌,分别占37.8%和9.6%。药敏试验显示5种非发酵菌对多种抗生素均表现为高度耐药或多重耐药,高于相关研究,差异有统计学意义(P≤0.05)。结论肺结核患者肺部感染非发酵菌的分离率较高,多重耐药现象严重,临床应重视非发酵菌感染和耐药性监测。

Objective To learn the clinical characteristics and resistance of pulmonary tuberculosis complicated with nonfermenting bacteria-associated lower respiratory tract infection, and provide basis for rational use of antimi- crobial drngs. Methods ATB bacteria identification system was used for the identification of clinical isolates, and K-B method for the drug sensitivity of non-fermenting bacteria. Results A total of 156 strains of non-fermenting bacteria were isolated from the lower respiratory tract specimens from patients with pulmonary tuberculosis, among which Pseudomonas aeruginosa was predominant, accounting for 46.5% , followed by Acinetobacter baumannii and Stenotrophomonas nutltophilia, 37.8% and 9.6% respectively. Susceptibility test showed that the five kinds of nonfermenters were highly resistant or multidrug-resistant to several antibiotics, higher than the results of other studies, with statistically significant difference （ P ≤ 0.05 ）. Conclusion The isolation rate of non-fermenting bac- teria in pulmonary tuberculosis patients is high and the pathogens are highly multi-drug resistant. Clinicians should pay more attention to the monitoring of non-fermenting bacteria and their resistance.