肺结核并发呼吸机相关性肺炎的病原菌特点及药敏性分析

Pathogenic bacteria characteristics and drug sensitivity of pulmonary tuberculosis with ventilator-associated pneumonia

目的探讨肺结核并发呼吸机相关性肺炎(VAP)的病原菌特点及临床药敏情况。方法选取2017年6月至2019年10月在广州市胸科医院接受机械通气的60例肺结核并发呼吸机相关性肺炎患者作为研究对象,通过采集标本、进行细菌培养、药敏实验及治疗效果来探讨分析肺结核并发呼吸机相关性肺炎病原菌特点及临床药敏情况。结果所有研究对象共检出120株菌株,革兰阴性菌株占比最高,真菌为仅次于革兰阴性菌株的菌株,革兰阳性菌株占比最低。检测出的革兰阴性菌株中,鲍曼不动杆菌占比最高,铜绿假单胞菌为仅次于鲍曼不动杆菌的菌株。占比最高的铜绿假单胞菌和鲍曼不动杆菌对常用的抗生素氨苄西林、复方磺胺、环丙沙星、左氧氟沙星、庆大霉素及头孢吡肟都具有很高的耐药性。结论肺结核并发呼吸机相关性肺炎病原菌中革兰阴性杆菌和真菌的占比处于较高水平,且其对常用抗生素具有较高的耐药性。

Objective To investigate the pathogenic bacteria characteristics and clinical drug sensitivity of pulmonary tuberculosis with ventilator-associated pneumonia( VAP). Methods From June2017 to October 2019,60 patients with pulmonary tuberculosis complicated with ventilator-associated pneumonia who received mechanical ventilation in Guangzhou Chest Hospital were selected as the research subjects. The characteristics and clinical drug sensitivity of pulmonary tuberculosis were analyzed by collecting specimens, carrying out bacterial culture, drug sensitivity experiment and therapeutic effect. Results A total of 120 strains were detected in all subjects,with the highest proportion of Gram-negative strains,the fungi being the second only to Gram-negative strains,and the lowest proportion of Gram-positive strains. Among the Gram-negative strains detected,acinetobacter baumannii accounted for the highest proportion,and pseudomonas aeruginosa was the second only strain after acinetobacter baumannii. The highest proportion of pseudomonas aeruginosa and acinetobacter baumannii were highly resistant to the commonly used antibiotics ampicillin,compound sulfanilamide,ciprofloxacin,levofloxacin,gentamicin and cefepime. Conclusions The proportion of gram-negative bacilli and fungi in pulmonary tuberculosis complicated with ventilator-associated pneumonia pathogens is at a high level,and its resistance to commonly used antibiotics is high.