肺结核合并肠杆菌科细菌下呼吸道感染的临床特征与病原学分析

Clinical features and etiological analysis of pulmonary tuberculosis complicated with enterobacter bacterial lower respiratory tract infection

目的探讨肺结核合并肠杆菌科细菌下呼吸道感染的临床特征、病原学分布和耐药特征,为临床合理规范使用抗菌药物提供参考。方法采用纸片扩散法(K-B)对病原菌进行药敏试验,并进行ESBLs检测,按CLSI 2012年标准判定药敏结果,用WHONET 5.6软件分析数据。结果从肺结核患者下呼吸道标本中共分离肠杆科细菌272株,主要为肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌,分别占45.6%、31.3%和10.7%;药敏试验表明5种细菌对碳青霉烯类抗菌药物耐药率低,均在10.0%以下,其余药物均有不同程度耐药,高于相关研究,差异有统计学意义(P<0.05)。结论肺结核患者下呼吸道感染肠杆菌科细菌的分离率较高,多重耐药现象严重,临床应重视肠杆菌科细菌感染和耐药性监测。

Objective Study the clinical characteristics, pathogen distribution and drug resistance characteristic of pulmonary tuberculosis with Enterobacteriaceae bacteria of lower respiratory tract infection, and provides the reference for the clinical ra- tional use of antibacterial drugs. Methods Do drug sensitive test by using Disc diffusion susceptibility testing to the pathogens, detect it with extended spectrum 13 -lactamases （ESBLs）, determine the result of drug sensitivity according to Clinical and La- boratory Standards Institute （CLSI） 2012 standard, and analyze data with WHONET 5.6. Results From pulmonary tuberculo- sis patients with lower respiratory tract specimens 272 strains of bacteria of intestinal rod were isolated, mainly for klebsiella pneumoniae, escheriehia eoli and enterobaeter cloacae, accounted for 45.6%, 31.3% and 10.7% ; drug sensitive test showed that 5 kinds of bacteria to carbapenem antibiotics resistance rate is low, under 10% , other drugs have different degrees of resist- ance, higher than the relevant research, the difference was statistically significant （ P 〈 0.05 ）. Conclusion Enterobacteriaceae bacteria in lower respiratory tract infection in patients with pulmonary tuberculosis is in high separation rate, multi - drug resist- ant phenomenon is serious, and clinical emphasis should be on bacterial infection of enterohacteriaeeae and monitor of antibiotic resistance.