重症肺炎合并肺结核患者的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in severe pneumonia patients with pulmonary tuberculosis

目的探究重症肺炎合并肺结核(PTB)患者的病原菌分布、耐药性以及治疗方法。方法对166例重症肺炎合并PTB患者进行分析,收集所有研究对象的痰标本,检测出相关病原菌的分布情况及对常见药物的耐药性,总结出对重症肺炎合并PTB患者最有效的治疗方法。结果166例患者中共培养出菌株188株,革兰氏阴性菌比例最大(57.45%),其次是革兰氏阳性菌(38.83%),真菌所占比例最小(3.72%);将感染率较高的革兰氏阳性菌肺炎链球菌、金黄色葡萄球菌及表皮葡萄球菌做耐药性分析,结果显示,利奈唑胺对上述革兰阳性菌的耐药率最低,其次为万古霉素,耐药率皆小于10%,红霉素、青霉素、克林霉素等对肺炎链球菌、金黄色葡萄球菌及表皮葡萄球菌耐药性较高。将感染率较高的革兰氏阴性菌肺炎克雷伯杆菌、铜绿假单胞菌及鲍曼不动杆菌做耐药性分析,结果显示,亚胺培南对上述3种细菌的耐药率分别为5.26%、17.39%、9.52%,耐药率较高的抗菌药物有红霉素、青霉素及克林霉素等;亚胺培南联合利奈唑胺(YL)组患者总细菌清除率略高于亚胺培南联合万古霉素(YW)组,YL组患者细菌清除、假设清除和替换人数均多于YW组,但组间比较差异无统计学意义(χ^(2)=0.276,P=0.599)。结论重症肺炎患者的病原菌分布具有独特性,利奈唑胺对于革兰氏阳性菌感染为主导的重症肺炎合并PTB的治疗效果明确,对细菌的清除率更高。

Objective To explore the distribution of related pathogens,resistance to common drugs and treatment methods in patients with severe pneumonia and pulmonary tuberculosis(PTB).Methods 166 patients with severe pneumonia and pulmonary tuberculosis were selected for study.The sputum samples of these patients were collected to detect the relevant pathogens and drug resistance.The most effective treatment method for patients with severe pneumonia and PTB was summarized.Results A total of 188 strains were cultured in 166 patients.The proportion of Gram-negative bacteria was the largest(57.45%),followed by Gram-positive bacteria(38.83%),and the proportion of Fungi was the smallest(3.72%).The drug resistance of Gram-positive bacteria Streptococcus pneumoniae,Staphylococcus aureus,and Staphylococcus epidermidis with high infection were analyzed.The results showed that the resistance rate of the above-mentioned Gram-positive bacilli to linezolid was lowest,followed to vancomycin 10%,but to erythromycin,penicillin,and clindamycin,the resistance rates were high.The drug resistance of Gram-negative bacteria Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii were analyzed.The results showed that the drug resistance rates of the above 3 kinds of bacteria to imipenem were 5.26%,17.39%and 9.52%,respectively.Antimicrobials with high resistance rates included erythromycin,penicillin,and clindamycin.The total bacterial clearance rate of patients in the imipenem combined with linezolid(YL)group was slightly higher than that in the imipenem combined with vancomycin(YW)group.The bacterial clearance,hypothetical clearance and replacement number of patients in the YL group was higher than in the YW group,but the difference between the 2 groups was not statistically significant(χ^(2)=0.276,P=0.599).Conclusion The distribution of pathogenic bacteria in patients with severe pneumonia is unique.Linezolid has a clear therapeutic effect on Gram-positive bacterial infection-led severe pneumonia combined with PTB,and has a higher clearance rate of bacteria.