120例人类免疫缺陷病毒感染患者血液中病原体的培养及其耐药状况分析

Analysis on Pathogens Culture and Current of Drug Resistance in Blood of 120 Patients Infected with Human Immunodeficiency Virus(HIV)

目的:分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染患者血液中病原体的分布,并探究了其耐药状况。方法:抽取医院2017年2月—2020年3月间被诊断为HIV感染患者120例病历资料,分析其送检标本的病原体培养与药敏试验结果。结果:120例HIV感染患者血液标本中,分离出病原菌25株;在检出的25株病原菌中,其中真菌10株(占40.00%,马尔尼菲篮状菌3株、新型隐球菌7株)、革兰阳性球菌8株(占32.00%,人葡萄球菌3株、松鼠葡萄球菌2株、表皮葡萄球菌2株和施氏葡萄球菌1株)、革兰阳性杆菌5株(占20.00%)和革兰阴性杆菌2株(占8.00%);细菌阳性平均报警时间为(16.0±0.5)h,真菌阳性平均报警时间为(53.0±3.2)h;25株检出阳性菌中,两者均为阳性3株(占12.00%),仅需氧瓶培养阳性14株(占56.00%),仅厌氧瓶培养8株(占32.00%);7株新型隐球菌对伏立康唑、氟康唑及两性霉菌B等3种抗真菌类药物均敏感,8株革兰阳性球菌(主要为凝固酶阴性葡萄球菌)中有3株为耐甲氧西林葡萄球菌(占37.50%);抗菌药物中利奈唑胺、万古霉素和庆大霉素对葡萄球菌敏感率达100.00%,而对克林霉素及红霉素均耐药;庆大霉素及复方磺胺甲噁唑对星形诺卡菌(Nocardia asteroides)较为敏感。结论:真菌感染为HIV患者感染的主要病原体,其中以新型隐球菌感染率为最高,临床应根据其药敏结果选用敏感率高的药物治疗,遏制其传播。

Objective: To analyze the distribution of pathogens in the blood of patients infected with human immunodeficiency virus(HIV), and to study the status of drug resistance. Methods: Medical records of 120 patients diagnosed with HIV infection from February 2017 to March 2020 were selected to analyze the pathogen culture and drug sensitivity test results of the samples submitted. Results: In the blood samples of 120 HIV infected patients, 25 strains of pathogenic bacteria were isolated. In the detection of 25 strains of pathogenic bacteria, the Fungus 10 strains(40.00%, 3 strains of Talaromyces marneffei, 7 strains of Cryptomyces neoformans), Gram positive coccus 8 strains Staphylococcus hominis(32.00%, 3 strains of Squirrels, 2 strains of Staphylococcus aureus, Staphylococcus epidermis Staphylococcus aureus strains and 1 strain of Staphylococcus Schleiferi), 5 strains(20.00%) were Gram positive bacillus and 2 strains of Gramnegative bacillus(8.00%). The mean alarm time for bacteria and fungi was(16.0±0.5) h and(53.0±3.2) h respectively. In the 25 positive strains, 3 strains(12.00%) were both positive, 14 strains(56.00%) were positive only by oxygen bottle culture, and 8 strains(32.00%) were positive only by anaerobic bottle culture.7 strains of Cryptococcus Neoformans were all sensitive to 3 kinds of antifungal drugs, including voriconazole, fluconazole and amphotericin B. Among the 8 strains of Gram-positive cocci(mainly Coagulase-negative Staphylococcus), 3 strains were methicillin-resistant Staphylococcus(37.50%). Among the antibiotics, linezolid, vancomycin and gentamicin were sensitive to Staphylococcus 100.00%, but resistant to clindamycin and erythromycin. Gentamicin and sulfamethoxazole were more sensitive to Nocardia asteroides. Conclusion: Fungal infection is the main pathogen of HIV infection, in which the infection rate of Cryptomyces neoformans is the highest. Clinically, drug treatment with high sensitivity rate should be selected based on its drug sensitivity results to prevent its transmission.