非结核分枝杆菌肺病患者非结核分枝杆菌和下呼吸道病原菌分布及耐药性分析

Distribution and Drug Resistance of Non-tuberculosis Mycobacteria and Lower Respiratory Tract Pathogens in Nontuberlosis Myeobactericum-induced Pulmonary Disease Patients

目的分析非结核分枝杆菌肺病患者非结核分枝杆菌和下呼吸道病原菌分布及耐药性。方法选取2014—2016年徐州医科大学附属徐州市传染病医院收治的非结核分枝杆菌肺病患者152例,采集其痰液标本进行培养、菌种鉴定及药敏试验。结果 (1)152例非结核分枝杆菌肺病患者共检出非结核分枝杆菌152株,分离鉴定出7个非结核分枝杆菌菌种,包括快速生长群64株(占42.11%),其中以龟/脓肿分枝杆菌(占78.13%)为主;缓慢生长群88株(占57.89%),其中以鸟分枝杆菌复合群(68.18%)为主。药敏试验结果显示,龟/脓肿分枝杆菌对链霉素、异烟肼、利福平的耐药率均为100.00%,鸟分枝杆菌复合群对链霉素、异烟肼、对氨基水杨酸、氧氟沙星的耐药率均为100.00%。(2)152例非结核分枝杆菌肺病患者下呼吸道样本共分离出病原菌88株,包括革兰阴性菌53株(占60.23%),真菌32株(占36.36%),革兰阳性菌3株(占3.41%)。革兰阴性菌以肺炎克雷伯菌(占22.64%)为主,真菌以白色假丝酵母菌(占84.37%)为主,革兰阳性菌均为金黄色葡萄球菌(占100.00%)。药敏试验结果显示,肺炎克雷伯菌对氨苄西林的耐药率为100.00%,对呋喃妥因的耐药率为83.33%,对其他常见抗菌药物敏感性较高。结论非结核分枝杆菌肺病患者非结核分枝杆菌以缓慢生长群为主,且对大部分常见抗菌药物耐药;下呼吸道病原菌以革兰阴性菌为主,且对大部分常见抗菌药物敏感;临床应根据药敏试验结果合理选择抗菌药物。

Objective To analyze the distribution and drug resistance of non-tuberculosis mycobacteria and lower respiratory tract pathogens in non-tuberlosis myeobactericum-induced pulmonary disease patients.Methods From 2014 to 2016,a total of 152 non-tuberlosis myeobactericum-induced pulmonary disease patients were selected in Xuzhou Hospital for Infectious Disease,Affiliated to Xuzhou Medical University,their sputum samples were collected to cultivate,identify and carry out the drug sensitivity test.Results (1)A total of 152 strains of non-tuberlosis myeobactericum were found,7 aspergilusnigers of nontuberlosis myeobactericum were isolated and identified,including 64 strains with rapid growth(accounting for 42.11%),mainly were Mycobacterium chelonae or Mycobacterium abscessus(accounting for 78.13%);88 strains with slow growth(accounting for 57.89%),mainly were Mycobacterium avium complex(68.18%).Drug sensitivity test results showed that,drug resistance rate of Mycobacterium chelonae or Mycobacterium abscessus to streptomycin,isoniazide and rifampicin was 100.00%,respectively;drug resistance rate of Mycobacterium avium complex to streptomycin,isoniazide,p-aminosalicylic acid and ofloxacin was 100.00%,respectively.(2)A total of 88 strains of lower respiratory tract pathogens were isolated,including 53 strains of Gramnegative bacteria(accounting for 60.23%),mainly were Klebsiella pneumoniae(accounting for 22.64%);32 strains of fungus(accounting for 36.36%),mainly were Candida albicans(accounting for 84.37%);3 strains of Gram-positive bacteria(accounting for 3.41%),all were Staphylococcus aureus(accounting for 100.00%).Drug sensitivity test results showed that,drug resistance rate of Klebsiella pneumoniae to ampicillin was 100.00%,to macrodantin was 83.33%,but Klebsiella pneumoniae was highly sensitive to other common antimicrobial agents.Conclusion In non-tuberlosis myeobactericum-induced pulmonary disease patients,mainly non-tuberculosis mycobacteria slowly grows with high drug resistance to most common antibacterial agents;Gram-negative bacteria is the major lower respiratory tract pathogens,which is sensitive to most common antibacterial agents;clinicians should properly choose antibacterial agents according to drug sensitivity test results.