初、复治肺结核合并肺部感染的病原菌及耐药性分析

Analysis of pathogens and drug resistance of initial and repeated treatment in pulmonary tuberculosis complicated with pulmonary infection

目的了解初、复治肺结核患者合并肺部感染的病原菌分布及耐药情况。方法对湖南省胸科医院2013年7月-2014年3月确诊的初、复治肺结核合并肺部感染的住院患者的痰或支气管肺泡灌洗液和咽拭子,进行培养以及药敏试验,用SPSS 16.0软件统计分析。结果初治组检出病原菌136株,复治组检出病原菌106株,初治组与复治组均以革兰阴性杆菌感染常见,初治组革兰阴性杆菌构成比(69.85%)明显高于复治组(53.77%)。复治组真菌构成比(33.02%)明显高于初治组(15.44%)。两组革兰阳性球菌和肺炎支原体构成比差异均无统计学意义。药敏结果显示,主要革兰阴性杆菌对哌拉西林-他唑巴坦、亚胺培南、美罗培南、阿米卡星和左氧氟沙星耐药率均≤50.00%,葡萄球菌对左氧氟沙星和阿奇霉素有一定的敏感性,对利奈唑胺全部敏感。念珠菌属和肺炎支原体对临床常用抗真菌药物敏感。结论初、复治肺结核合并肺部感染的病原菌谱不同,复治组比初治组细菌耐药严重。

Objective To investigate pathogens and drug resistance of initial and repeated treatment in pulmonary tuberculosis complicated with pulmonary infection. Methods Sputum or bronchial alveolar lavage fluids and swabs of active pulmonary tuberculosis patients complicated with pulmonary infection including initial treatment and repeated treatment from July 2013 to March 2014 in Hunan Chest Hospital were cultured,and isolated pathogens were identified and performed antimicrobial susceptibility test. Results 136 and 106 pathogens were isolated from initial treatment and repeated treatment group respectively. Among them,gram- negative bacilli were the common pathogens,constitution ratio（ 69. 85%） of gram- negative bacilli in initial treatment group was significantly higher than that（ 53. 77%） in repeated treatment group. Constitution ratio（ 33. 02%） of fungi in repeated treatment group was significantly higher than that（ 15. 44%） in initial treatment group. Constitution ratio of gram- positive coccus and Mycoplasma pneumonia showed no statistical significance between two groups. Susceptibility results showed that the resistance rates of main gram- negative bacilli to piperacillin- tazobactam,imipenem,meropenem,amikacin and levofloxacin were lower than 50. 00%. Staphylococcus aureus kept certain sensitive to levofloxacin and azithromycin and all sensitive to linezolid. Candida and Mycoplasma pneumonia were sensitive to antimicrobial agents commonly used in clinical.Conclusion Pathogens distribution is different between initial and repeated treatment pulmonary tuberculosis patients complicated with pulmonary infection. Bacterial drug resistance of treatment group is more serious than that of initial group.