骨与关节结核患者病灶感染病原菌检测结果分析

Distribution of pathogens causing focal infections in patients with bone and joint tuberculosis

目的分析临床诊断骨与关节结核患者病灶感染病原菌的种类和耐药性,为临床抗结核治疗方案的制定提供参考。方法选取医院收治的临床诊断骨与关节结核并接受手术治疗的患者58例,收集所有患者病灶部位的脓液、坏死组织、肉芽组织等作为标本进行病原菌培养和药敏试验,对比不同临床资料患者的病原菌培养阳性率并分析病原菌的耐药性。结果 58份标本中分枝杆菌属培养阳性率为56.90%;15份抗酸染色阳性的标本中,分枝杆菌属培养阳性率为93.33%,显著高于抗酸染色阴性的标本(P<0.05);31例有结核中毒症状患者的标本中,分枝杆菌属培养阳性率为70.97%,显著高于无结核中毒症状患者的标本(P<0.05);共培养出结核分枝杆菌20株、牛分枝杆菌8株、肺结核分枝杆菌5株;其中12株为耐药株,占36.36%,其对链霉素和异烟肼的耐药率最高,达75.00%,对磺胺甲氧嗪的耐药率最低,为0。结论结核分枝杆菌是骨与关节结核主要的病原菌,分枝杆菌属对链霉素、异烟肼的耐药率较高,临床上应重视药敏试验,以指导临床抗结核药物的选择,提高临床治疗效果,减少耐药菌株的产生。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing focal infections in the patients with clinically confirmed bone and joint tuberculosis so as to provide guidance for clinical anti-tuberculosis treatment.METHODS A total of 58 patients with confirmed bone and joint tuberculosis who were treated in the hospital were enrolled in the study,then the pus,necrosis tissues,granulation tissues were sampled from the lesion sites for the culture of pathogens,the drug susceptibility testing was performed,the positive rate of culture of pathogens was compared among the patients who had different clinical data,and the drug resistance of the pathogens was analyzed.RESULTS Among the 58 specimens,the positive rate of culture of Mycobacteria was56.90%;the positive rate of culture of Mycobacteria was 93.33%in the 15 positive acid-fast staining specimens,significantly higher than that in the negative acid-fast staining specimens.The positive rate of culture of Mycobacteria was 70.97%in the specimens obtained from the 31 patients with poisoning symptom of tuberculosis,significantly higher than that in the specimens obtained from the patients without poisoning symptom of tuberculosis（P〈0.05）.Totally 20 strains of Mycobacterium tuberculosis,8strains of Mycobacterium bovis,and 5strains of M.tuberculosis have been isolated,among which 12 isolates were drug-resistant strains,accounting for 36.36%.The drug resistance rate to streptomycin and isoniazid was the highest（75.00%）,and the drug resistance rate to sulfamonomethoxine triazine was the lowest 0.CONCLUSION M.tuberculosis is the predominant species of pathogen causing the bone and joint tuberculosis.The Mycobacteriastrains are highly resistant to streptomycin and isoniazid.It is necessary for the hospital to focus on the drug susceptibility testing so as to provide guidance for use of anti-tuberculosis drugs,raise the clinical therapeutic effect,and reduce the drug-resistant strains.