肺结核患者下呼吸道感染病原菌耐药性分析

Drug resistance of common species of pathogens causing lower respiratory tract infections in tuberculosis patients

目的了解医院肺结核患者下呼吸道感染病原菌分布及耐药性,为合理使用抗菌药物和医院感染控制提供参考依据。方法对2010年1月-2012年12月1 120例经临床确诊为肺结核继发呼吸道感染患者送检的痰液标本进行病原菌培养;采用VITEK-2Compact全自动微生物分析仪进行病原菌和耐药率细菌鉴定及药敏试验,采用WHONET 5.6软件进行统计分析。结果 1 120份痰液标本共分离出病原菌1 583株,其中革兰阴性菌1 402株占88.6%,革兰阳性菌140株占8.8%,真菌41株占2.6%;铜绿假单胞菌和鲍氏不动杆菌多药耐药性严重;检出产ESBLs大肠埃希菌和肺炎克雷伯菌为75株和99株,检出率分别为81.5%和39.4%,肺炎克雷伯菌、褪色沙雷菌和大肠埃希菌对亚胺培南的耐药率为16.3%、6.3%和13.0%;未发现耐万古霉素金黄色葡萄球菌。结论肺结核继发下呼吸道感染患者主要以革兰阴性杆菌为主,常见病原菌耐药性较为严重,应加强病原菌耐药监测,以指导合理用药和医院感染控制。

OBJECTIVE To understand the distribution and drug resistance of pathogens causing lower respiratory tract infections in the patients with pulmonary tuberculosis so as to provide guidance for reasonable use of antibiotics and control of nosocomial infections.METHODS From Jan 2010to Dec 2012,totally 1 120sputum specimens that were cultured positive were collected,then the pathogens isolated from the sputum specimens obtained from the patients with clinically confirmed pulmonary tuberculosis complicated with secondary respiratory tract infections were retrospectively analyzed,the bacterial identification and drug susceptibility testing for the pathogens were carried out by using VITEK-2Compact automatic microorgnism analyzer,and the statistical analysis was performed with the use of WHONET 5.6software.RESULTS A total of 1 583strains of pathogens have been isolated from the 1 120sputum specimens,consisting of 1 402（88.6%）strains of gram-negative bacteria,140（8.8%）strains of gram-positive bacteria,and 41（2.6%）strains of fungi.The Pseudomonas aeruginosa and Acinetobacter baumannii were highly multidrug-resistant.There were 75strains of ESBLs-producing Escherichia coli and 99strains of ESBLs-producing Klebsiella pneumoniae isolated,with the isolation rate of 81.5% and39.4%,respectively.The drug resistance rate of the K.pneumoniaeto imipenem was 16.3%,the Serratia marcescens 6.3%,the E.coli 13.0%. No vancomycin-resistant Staphylococcus aureus has been detected.CONCLUSIONThe gram-negative bacilli are the predominant pathogens causing the secondary lower respiratory tract infections in the pulmonary tuberculosis patients;the common species of pathogens are highly resistant.It is necessary to strengthen the surveillance of drug resistance of pathogens so as to guide the reasonable use of antibiotics and control of nosocomial infections.