肺结核合并肺部感染患者的病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria in patients with pulmonary tuberculosis complicated with pulmonary infection

目的:分析肺结核合并肺部感染患者病原菌分布特点及其耐药性。方法:选取86例肺结核合并肺部感染患者作为研究对象。患者均留取痰液标本,进行病原菌培养、分离鉴定和药敏试验,统计病原菌分布情况,并分析主要致病菌的耐药性。结果:86例肺结核合并肺部感染患者共分离出108株病原菌,革兰阴性菌占比最高(51.85%),革兰阳性菌次之(37.04%),真菌最低(11.11%)。大肠埃希菌对哌拉西林耐药性最高,肺炎克雷伯菌、铜绿假单胞菌对氨苄西林耐药性最高,金黄色葡萄球菌、肺炎链球菌、表皮葡萄球菌对青霉素耐药性最高;白色假丝酵母菌对酮康唑耐药性最高。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对亚胺培南、阿米卡星敏感性最高,金黄色葡萄球菌、肺炎链球菌和表皮葡萄球菌对万古霉素敏感性最高,白色假丝酵母菌对两性霉素B敏感性最高。结论:肺结核合并肺部感染患者痰培养病原菌以革兰阴性菌为主,对哌拉西林、氨苄西林、青霉素等药物耐药性较高,临床需结合药敏试验选取适宜药物。

Objective:To analysis distribution and drug resistance of pathogenic bacteria in patients with pulmonary tuberculosis complicated with pulmonary infection.Methods:86 patients with pulmonary tuberculosis complicated with pulmonary infection were selected as the research objects.The sputum samples were collected for pathogen culture,isolation and identification,and drug sensitivity test.The distribution of pathogenic bacteria was statistically analyzed and the drug resistance of the main pathogens was analyzed.Results:108 pathogenic bacteria were isolated from the 86 patients with pulmonary tuberculosis and pulmonary infection.Gram-negative bacteria accounted for the highest proportion(51.85%),followed by gram-positive bacteria(37.04%),and fungi were the least(11.11%).In terms of drug resistance,Escherichia coli had the highest resistance to Piperacillin,Klebsiella pneumoniae and Pseudomonas aeruginosa had the highest resistance to Ampicillin,and Staphylococcus aureus,Streptococcus pneumoniae and Staphylococcus epidermidis had the highest resistance to Penicillin;Candida albicans had the highest resistance to Ketoconazole.In terms of sensitivity,Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa were most sensitive to Imipenem and Amikacin,and Staphylococcus aureus,Streptococcus pneumoniae and Staphylococcus epidermidis were most sensitive to Vancomycin,and Candida albicans was most sensitive to Amphotericin B.Conclusions:The pathogens in the sputum culture of the patients with pulmonary tuberculosis and pulmonary infection are mainly Gram-negative bacteria,and they are highly resistant to Piperacillin,Ampicillin,Penicillin and other drugs.Therefore,it is necessary to select appropriate drugs in combination with drug susceptibility tests in the clinical practice.