黏质沙雷菌致肺结核患者感染的相关危险因素与耐药性研究

Risk factors and drug resistance analysis of Serratia marcescens infection in patients with pulmonary tuberculosis

目的探讨黏质沙雷菌致肺结核患者感染的相关危险因素、产β-内酰胺酶情况和耐药性,为临床合理用药提供依据。方法选取确诊的肺结核合并黏质沙雷菌感染患者为观察组,同期确诊的单纯肺结核患者为对照组,分析感染的危险因素,采用WHONET 5.6软件分析药敏试验结果。结果使用广谱抗菌药物、应用糖皮质激素、进行侵入性诊疗等均是引起肺结核合并黏质沙雷菌感染的危险因素;该菌在痰液标本中检出率最高,占84.9%;产ESBLs率为32.1%,产AmpC酶率为26.4%,同时产ESBLs和AmpC酶菌占9.4%,产碳青霉烯酶率为5.7%;药敏试验表明该菌对临床多数常用抗菌药物出现不同程度的耐药,其中对头孢唑林、头孢呋辛100.0%耐药。结论尽量减少侵入性操作,合理使用抗菌药物,积极治疗原发病,有利于预防肺结核合并黏质沙雷菌感染。该菌多重耐药现象较为严重,耐药性的产生与产ESBLs、AmpC酶和碳青霉烯酶有关。

Objective To investigate the risk factors, β-lactamase production, and drug resistance of pulmonary tuberculosis caused by Serratia marcescens, so as to provide basis for clinically rational selection of antimicrobial drugs. Methods The hospitalized patients with tuberculosis and Serratia marcescens infection were selected as the observation group, hospitalized patients with simple pulmonary tuberculosis in the same period were selected as control group, the risk factors for infection was analyzed, and WHONET 5.6 software was used to analyze drug sensitivity test results. Results Use of broad-spectrum antibiotics, use of glucocorticoids, invasive treatment were all risk factors for pulmonary tuberculosis infection with serratia marcescens infection;Serratia marcescens had the highest detection rate in sputum samples, accounting for 84.9%;the producing rate of ESBLs was 32.1%, the production rate of AmpC enzyme was 26.4%, ESBLs and AmpC producing bacteria accounted for 9.4%, and the rate of carbapenemase production was 5.7%;drug susceptibility test showed that Serratia marcescens showed different degrees of resistance to most clinically used antimicrobial agents, among which 100.0% were resistant to cefazolin and cefuroxime. Conclusion Minimizing invasive operations, rational use of antibiotics, and active treatment of the primary disease were beneficial to the prevention of pulmonary tuberculosis in patients infected with Serratia marcescens. The multidrug resistance of Serratia marcescens was more serious, and the production of drug resistance was related to the production of ESBLs, AmpC enzymes and carbapenemase.