艾滋病患者感染病原菌分布及耐药性

Distribution and drug resistance of pathogens causing infections in AIDS patients

目的探讨艾滋病(AIDS)患者感染病原菌的特点及其耐药性,为临床早期诊断及合理用药提供科学依据。方法回顾性分析2010年1月-2012年5月278例AIDS患者骨髓或(和)血液需氧菌培养结果,采用SPSS 11.0统计软件进行统计分析。结果 278例AIDS患者中有268份血液样本,共分离到66株病原菌,有263份骨髓样本,共分离到80株病原菌,检出病原菌均以马尔尼菲青霉菌为主,在血液及骨髓中分别占86.5%、81.3%;257例患者同时进行骨髓及血液联合培养,检出马尔尼菲青霉菌74株,骨髓及血液单一培养马尔尼菲青霉菌检出敏感性分别为87.8%和73.0%,两者与联合培养结果比较差异均有统计学意义(P<0.01);革兰阳性菌除了马红球菌以外,均出现不同程度的耐药性,未见耐万古霉素菌株;革兰阴性菌对碳青霉烯类抗菌药物100.0%敏感,对美洛西林100.0%耐药,新型隐球酵母菌对两性霉素B和制霉菌素100.0%敏感,结核分枝杆菌对一线和二线抗结核药物100.0%敏感。结论 AIDS患者血液系统病原菌感染以马尔尼菲青霉菌为主,骨髓及血液联合培养对提高马尔尼菲青霉菌检出率有重要意义。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing infections in the AIDS patients so as to provide scientific basis for early clinical diagnosis and reasonable use of antibiotics .METHODS A total of 278 AIDS patients who were treated in the hospital from Jan 2010 to May 2012 were recruited as the study objects ,then the results of culture of aerobic bacteria from bone morrow or blood were retrospectively analyzed , and the statistical analysis was performed by using SPSS 11 .0 software .RESULTS Totally 66 strains of pathogens have been isolated from 268 submitted blood specimens that were obtained from the 278 AIDS patients ,and 80 strains of pathogens have been isolated from 263 submitted bone marrow specimens ;Penicillium marne f f ei was the predominant species of isolated pathogens ,accounting for 86 .5% among the pathogens isolated from the blood specimens and 81 .3% among the pathogen isolated from the bone marrow specimens . Totally 74 strains of P .marne f f ei have been isolated from the joint culture of bone marrow and blood for 257 patients ,the sensitivi‐ties of single culture of P .marnef fei from bone marrow and blood were respectively 87 .8% and 73 .0% ,as com‐pared with the results of joint culture ,the difference was statistically significant （P〈0 .01） .The gram‐positive bacteria varied in the drug resistance except for Rhodococcus equi ,and no vancomycin‐resistant strain has been de‐tected ;the drug susceptibility rate of the gram‐negative bacteria to carbapenems was 100 .0% ,the drug resistance rate to mezilocillin was 100 .0% ,the drug susceptibility rates of the Cryptococcus neoformans to amphotericin B and nystatin were 100 .0% ,and the drug susceptibility rates of the Mycobacterium tuberculosis to the first‐line and second‐line antituberculosis drugs were 100 .0% .CONCLUSION The P .marnef fei is the predominant species of pathogen causing infection in the AIDS patients ,and it is of great significance to conduct the joint culture of bone marrow and blood so as to raise the detection rate of P .marne f f ei .