耐多药肺结核患者呼吸道感染的病原菌耐药性分析

Analysis of pathogen resistance in MDR-TB patients with respiratory infections

目的了解耐多药肺结核患者呼吸道感染的病原菌分布及耐药性,为正确选择抗菌药物治疗提供依据。方法选取2007年1月-2013年1月治疗的耐多药肺结核患者87例,采集患者痰标本进行培养及药敏试验,分析病原菌种类及耐药性,数据采用SPSS13.0软件进行统计分析。结果 87例患者痰标本培养出病原菌178株,其中革兰阴性菌124株占69.66%,革兰阳性球菌12株占6.74%,真菌42株占23.60%;金黄色葡萄球菌对氨苄西林、阿奇霉素及青霉素G的耐药率分别为100.00%、85.71%及100.00%;肺炎克雷伯菌对头孢噻肟、氨曲南、环丙沙星的耐药率分别为97.37%、94.94%、97.37%;真菌对酮康唑、氟康唑、伊曲康唑、伏立康唑有不同程度的耐药性,对两性霉素B的耐药率为0。结论革兰阴性杆菌是耐多药肺结核患者呼吸道感染的主要病原菌,真菌感染的比例较大,革兰阳性菌和革兰阴性菌均对常用的抗菌药物的耐药性较高,临床应根据细菌培养及药敏试验结果选用合理的抗菌药物,以增强疗效及降低耐药率。

OBJECTIVE To understand the distribution and drug resistance of pathogens for respiratory tract infections in patients with multidrug resistant pulmonary tuberculosis,and provide the basis for correct choice of antimicrobial drugs.METHODS Totally 87 patients who treated for multidrug resistant pulmonary tuberculosis from Jan.2007 to Jan.2013 were selected,their sputum were collected for culture and drug sensitivity test to analyze the pathogen distribution and drug resistance.Data were statistically analyzed by SPSS 13.0.RESULTS From the sputum samples of 87 patients,178pathogens were detected including 124 strains of gram negative bacteria（69.66%）and 12 strains of gram positive bacteria（6.74%）and 42 strains of fungi（23.60%）.The resistance of Staphylococcus aureus to ampicillin,azithromycin and penicillin was 100.00%,85.71% and100.00%,respectively.The resistance of Klebsiella pneumonia to cefotaxime,aztreonam,ciprofloxacin was97.37%,94.94% and 97.37%,respectively.Fungi had different degrees of resistance to ketoconazole,fluconazole,ltraconazole,and voriconazole,and 0%to amphotericin.CONCLUSIONS Gram negative bacteria are the main pathogens for respiratory tract infections in patients with multidrug resistant pulmonary tuberculosis.The proportion of patients with fungal infection is high.Gram positive and gram negative bacteria have high resistance rate to common antibiotics,therefore antimicrobial drugs should be selected based on susceptibility results in the clinical treatment.