肺结核患者肺部感染的影响因素分析及病原学研究

Influencing factors and etiology of pulmonary infections in tuberculosis

目的对肺结核患者肺部感染的影响因素进行分析,研究感染病原菌及药敏率,为临床治疗提供参考。方法选择医院2011年6月-2013年6月住院的肺结核患者167例,对其中68例肺部感染患者的影响因素进行分析,留取痰液标本进行病原菌培养及药敏试验,所有数据采用SPSS13.0进行分析。结果 167例肺结核患者发生肺部感染68例,感染率40.72%;共分离培养出病原菌74株,革兰阴性菌40株占54.05%,革兰阳性菌12株占16.22%,真菌22株占29.73%;革兰阴性菌对庆大霉素、头孢他啶、哌拉西林/他唑巴坦等广泛耐药,对美罗培南、亚胺培南敏感性较高,革兰阳性菌对万古霉素、替考拉宁敏感性较高;高龄、抗菌药物使用、合并糖尿病、营养状况差、合并慢性支气管炎、有低蛋白血症、复治等是感染的主要影响因素。结论肺结核患者容易合并肺部感染,且影响因素众多,感染的病原菌以条件致病菌为主,且对临床常用抗菌药物耐药率较高,应加强对高危患者的干预,同时加强病原菌分离和耐药性监测。

OBJECTIVE To analyze influencing factors for pulmonary infections in tuberculosis and study infection pathogens and drug sensitivity, so as to provide a reference for clinical treatment. METHODS Totally 167 tuberculosis patients hospitalized in Jun. 2011 to Jun, 2013 were selected, including 68 patients with pulmonary infections, the influencing factors for infection were analyzed and sputum specimens were taken for pathogen culture and sensitivity test. Data were analyzed with SPSS13.0. RESULTS There were 68 cases of infections in the 167 patients with tuberculosis, the infection rate was 40.72 %. Totally 74 pathogens were isolated and cultured, including 40 gram-negative bacteria, accounting for 54.05 %; 12 gram-positive bacteria, accounting for 16.22%; 22 fungi, accounting for 29.73%. The gram-negative bacteria had extensive resistance to gentamicin, ceftazidime, piperacillin/tazobactam, and a relatively high resistance to meropenem and imipenem, the gram-positive bacteria had a relatively high resistance to vancomycin and teicoplanin. The main factors affecting infections included advanced age, antibiotic use, diabetes, poor nutrition, chronic bronchitis, combined hypoalbuminemia, and retreatment. CONCLUSION Pulmonary tuberculosis patients are prone to have pulmonary infections, and influencing factors are various, pathogens are mainly opportunistic pathogens and have high antimicrobial resistance rates in the clinical treatment, clinicians should pay attention to strengthen intervention for the high-risk patients and the monitoring of drug resistance and pathogen isolation.