获得性免疫缺陷综合征肺部感染患者痰微生物学检查结果分析

Analysis of results of sputum microbiological culture in acquired immunodeficiency syndrome patients associated with pulmonary infection

目的：了解2014年至2015年获得性免疫缺陷综合征（AIDS）住院患者痰培养的致病菌分布特点,为临床判断肺部感染的性质及合理选用抗菌药物提供依据。方法：对住院AIDS患者中疑似肺部感染的471例患者常规留取痰标本,并进行细菌、真菌及分枝杆菌培养,对其中痰培养阳性的患者进行统计学分析。结果：471例患者痰培养中检测出45种病原菌,共659例次,其中普通细菌113例次（17.1%）、真菌413例次（62.7%）、分枝杆菌133例次（20.2%）。普通细菌中革兰阴性菌共82例次（82/113,72.6%）,排名前3位的分别是鲍曼不动杆菌（16例次）、肺炎克雷伯杆菌（14例次）及铜绿假单胞菌（14例次）。革兰阳性菌共31例次（31/113,27.4%）,排名前3位的分别是凝固酶阴性葡萄球菌（19例次）、金黄色葡萄球菌（9例次）及肠球菌属（2例次）。真菌中排名前3位的分别是白假丝酵母菌（316例次）、其他假丝酵母菌（62例次）及曲霉菌（14例次）。分枝杆菌中非结核分枝杆菌69例次、结核分枝杆菌53例次、未分型者11例次。471例患者中349例痰培养测出1种病原菌,122例可检测出2种以上的病原菌,经χ~2检验分析,CD4≤100个/μL的患者较CD4〉100个/μL的患者痰中更容易检测出2种以上的致病菌（P=0.008）。结论：AIDS患者痰培养中致病菌种类繁多,且容易发生混合感染,尤其在CD4低下的患者中。

Objective To analysis the distribution of pathogenic bacteria in sputum culture of acquired immunodeficiency syndrome（AIDS） patients from 2014-2015 for providing a reference to facilitate the diagnosis and selecting appropriate anti-bacterial agents. Methods Hospitalized AIDS patients with suspected pulmonary infection were given sputum culture for bacteria, fungi and mycobacterium. The culture results were statistically analyzed. A total of 471 patients had659 episodes of positive sputum culture, including 113（17.1%） episodes of common bacteria, 413（62.7%） of fungi and133（20.2%） of mycobacterium. Among cultures of common bacteria, 82（72.6%） were gram negative bacteria and 31（27.4%） were gram positive bacteria. Among gram negative bacteria, the most commonly seen pathogens were Acinetobacter baumanii（n =16）, Klebsiella pneumoniae（n =14） and Pseudomonas aeruginosa（n =14）. Among gram positive bacteria,the top three pathogens were coagulase negative Staphylococcus（n =19）, Staphylococcus aureus（n =9） and Enterococcus（n=2）. The most commonly seen fungi include Candida albicans（n=316）, other Candida（n=62 cases） and Aspergillus（n=14）. Among cultures of mycobacterium, 69 were Mycobacterium non-tuberculosis, 53 were Mycobacterium tuberculosis and the rest 11 were uncategorized. Of the 471 patients, 349（74.1%） had only 1 pathogen detected by sputum culture. The rest122 patients（25.9%） had 2 or more pathogens detected. CD4≤100/μL was associated with culture of 2 or more pathogens（P=0.008）. Conclusions AIDS patients have a wide variety of pathogens detected by sputum culture, and mixed infection is common, especially among those with a low CD4 count.