124例菌阳肺结核患者合并下呼吸道感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in 124 cases with pulmonary tuberculosis combined with lower respiratory tract infection

目的通过对124例合并下呼吸道感染的菌阳肺结核患者的菌种分布及药敏结果进行分析,掌握本院菌阳肺结核患者合并下呼吸道感染的流行趋势及耐药特征,为临床合理用药提供参考依据。方法对已确诊的菌阳肺结核合并下呼吸道感染的患者共124株病原菌进行培养并做药敏。结果 124株病原菌中革兰氏阳性菌15株,占12.10%,其中金黄色葡萄球菌3株(2.42%),表皮葡萄球菌3株(2.42%),溶血葡萄球菌9株(7.26%),对万古霉素高度敏感,革兰氏阴性菌60株,占48.38%,其中肺炎克雷伯菌肺炎亚种15株(12.10%),铜绿假单胞菌12株(9.68%),阴沟肠杆菌10株(8.06%),大肠埃希菌4株(3.23%),其他共计19株(15.31%),肺炎克雷伯菌肺炎亚种,大肠埃希菌均对亚胺培南、美罗培南敏感。真菌49株,有曲霉菌4株,余45株为假丝酵母菌,对除天然耐药以外的个别药物,均显敏感。结论合并下呼吸道感染的菌阳肺结核患者以真菌和革兰氏阴性杆菌感染为主,耐药情况较为严峻,临床工作中应重视细菌培养和药敏实验。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in 124 cases with pulmonary tuberculosis combined with lower respiratory tract infection,to grasp the epidemic trends and the characteristics of drug resistance in patients with pulmonary tuberculosis combined with lower respiratory tract infection in the hospital,and provide reference for clinical rational drug uses. Methods A total of 124 strains of pathogenic bacteria were cultured and drug sensitivity tests were performed on the patients who had been diagnosed with pulmonary tuberculosis combined with lower respiratory tract infection. Results There were 15 strains of Gram- positive cocci（ G ＋）（ 12. 10%）,which included 3 strains of staph- ylococcus aureus（ 2. 42%）,3 strains of staphylococcus epidermidis（ 2. 42%）,and 9 strains of staphylococcus haemolyticus（ 7. 26%） and they were highly sensitive to vancomycin. There were 60 strains of Gram- negative bacilli（ G-）（ 48. 38%）,which included 15 strains of klebsiella pneumoniae subspecies（ 12. 10%）,12 strains of pseudomonas aeruginosa（ 9. 68%）,10 strains of enterobacter cloacae（ 8. 06%）,4 strains of Esche- richia coli（ 3. 23%）,19 strains of enterobacter cloacae（ 15. 31%）. Pneumoniae subspecies and Esche- richia coli were both sensitive to imipenem and meropenem. There were 49 strains of fungus,4 strains of aspergillus and 45 strains of candida. Except for some drugs,they were all showed sensitivity. Conclusion The main pathogenic bacteria of pulmonary tuberculosis patients with lower respiratory tract infection in the hospital were Gram- negative bacteria and fungus. Drug resistance of the bacteria was severe,which indicated that we should pay attention to bacterial culture and drug sensitivity test.