肺结核合并肺部感染的临床研究(英文)

Pulmonary tuberculosis and bacterial pneumonia co-infection:a clinical etiology investigation in China

目的描述肺结核合并病原菌感染菌谱特征,并分析造成合并感染的危险因素及耐药特点,为临床早期及合理治疗提供依据。方法收集2009.6-2012.6首都医科大学附属北京胸科医院(国家结核病临床中心)所有确诊为肺结核、肺结核或肺癌合并社区获得性肺炎(CAP)或医院获得性肺炎(HAP)的患者临床资料进行回顾性分析。计算比值比(OR),并进行多因素logistic回归分析,找出与共同感染有关的危险因素。收集的临床资料包括年龄、性别、初复治、合并症、影像学资料和血常规及结核分枝杆菌和其他病原菌培养均为阳性的药敏结果。结果肺结核合并感染中占首位的致病菌为铜绿假单胞杆菌25%(66/268)。肺空洞(OR=0.57,95%CI:0.43-0.75,=0.000),女性患者(OR=0.61,95%CI:0.45-0.82,P=0.000)和40-59岁(OR=1.79,95%CI:1.30-2.26,P=0.000)均与合并感染相关呈显著相关性。结核分枝杆菌培养阳性的肺结核中有2株耐甲氧西林金黄色葡萄球菌(MRSA)、5株泛耐药铜绿假单胞菌、2株泛耐药鲍曼不动杆菌合并感染。广泛耐药结核病(Extensively drug-resistant tuberculosis,XDR-TB)病例中,培养出普通细菌对四类抗生素(青霉素类、头孢菌素类、氨基糖苷类、喹诺酮类)均出现耐药情况。结论研究结果强调有必要制定结核分枝杆菌合并普通细菌性肺炎感染的特殊治疗方案,以及实施定期监测耐药情况的调查。

Pulmonary tuberculosis with bacterial pneumonia co-infection represents an additional treatment challenge over tuberculosis alone. However, little information is available on this co-infection in China. We performed a retrospective in vestigation of all pulmonary tuberculosis and bacterial pneumonia co infection cases at the National Tuberculosis Clinical Center of China （Beijing Chest Hospital） from June 2009 to June 2012. We calculated the odds ratios （OR） and performed multivariate logistic regression analysis to identify the risk factors associated with co-infection. M. tuberculosis and pathogenic bacteria co- infection were identified and tested for drug resistance using standard methods. The spectra of pathogenic bacteria isolated from pneumonia and tuberculosis co-infection were distinctive. The most predominant pathogen was Pseudornonas aeruginosa （25%, 66/268）. Pulmonary cavities （adjusted OR=0.57, 95G CI： 0.43-0.75, P=0. 000）, female （adjusted OR=0.61, 95% CI： 0.45-0.82, P=0. 000） and the age of 40 59 （adjusted OR=I. 79, 95% CI： 1.30-2.26, P=0. 000） were significantly correla- ted with the co-infection. Two strains of methicillin resistant S. aureus（MRSA）, 5 strains of pan-drug resistant P. aeruginosa, and 2 strains of pan-drug-resistant Acinetobacter baumannii were isolated from the culture-positive tuberculosis patients. Our findings highlight the need to develop and implement investigations of tuberculosis and bacterial pneumonia co-infection as well as the need to comprehensively treat the co-infection and routinely monitor drug-resistant cases.