煤工尘肺结核合并嗜麦芽窄食单胞菌医院感染36例临床分析

Clinical analysis on 36 cases of coal workers' pneumoconiosis complicated with pulmonary tuberculosis and nosocomial infection of stenotrophomonas maltophilia

目的探讨煤工尘肺结核患者合并嗜麦芽窄食单胞菌医院感染的临床特点。方法对36例煤工尘肺结核合并嗜麦芽窄食单胞菌医院感染患者的临床资料进行回顾性分析。结果该36例患者3次以上痰培养的结果均为嗜麦芽窄食单胞菌阳性,临床表现以咳嗽、咯痰、发热和肺部湿性啰音为主,胸部X射线检查结果多呈淡薄、斑片状浸润阴影。药敏试验结果表明,嗜麦芽窄食单胞菌广泛耐药,对亚胺培南、头孢吡肟、氨曲南、头孢哌酮的耐药率依次为100.0%、96.1%、94.5%和89.8%;对复方磺胺甲恶唑、环丙沙星、左氧氟沙星及庆大霉素敏感率均>60.0%。经抗结核治疗,并依据痰培养结果选择2种或2种以上敏感抗生素联合治疗,治愈21例(占58.3%),好转2例(占5.6%),无明显改善3例(占8.3%),死亡10例(占27.8%)。结论煤工尘肺结核合并嗜麦芽窄食单胞菌医院感染患者临床表现不典型,细菌耐药严重,及时进行病原菌培养与药敏试验对于诊断和治疗有重要意义。

Objective To investigate the clinical characteristics of the coal workers＇ pneumoconiosis（ CWP） complicated with both tuberculosis and nosocomial infection of stenotrophomonas maltophilia. Methods The clinical data of 36 CWP patients complicated with tuberculosis and nosocomial infection of stenotrophomonas maltophilia were collected and retrospectively analyzed. Results The results of sputum cultured for more than 3 times showed positive stenotrophomonas maltophilia. The main clinical manifestations were cough,sputum,fever and wet rale of lung. Most of the chest X-rays showed light and patchy infiltrated shadows. Drug susceptibility testing indicated that this kind of bacteria was extensively drug-resistant. The drug resistance rates to imipenem,cefepime,aztreonam and cefoperazone were 100. 0%,96. 1%,94. 5% and 89. 8%,respectively. The sensitivity of patients to sulfanilamide methyl isopropyl pbo, ciprofloxacin,levofloxacin and gentamicin were 60. 0%. After antituberculosis therapy combined with 2 or more sensitive antibiotics treatment based on the sputum cultured results,there were 21 cases（ 58. 3%） cured,2 cases（ 5. 6%） improved,3 cases（ 8. 3%） ineffective and 10 cases（ 27. 8%） dead. Conclusion The clinical features of tuberculopneumoconiosis combined with the nosocomial infection of stenotrophomonas maltophilia are un-typical. This disease is severely antibiotic-resistant.Timely pathogenic bacteria culture and drug sensitivity test have important significance in diagnosis and treatment.