结核病专科医院患者胸腔积液中病原菌分布及耐药情况分析

Analysis of microbial distribution and drug resistance of pathogens in pleural effusion in tuberculosis specialized hospitals

目的了解结核病专科医院患者胸腔积液中病原菌分布和耐药特点。方法应用WHONET 5.6软件对2020年1-12月本院胸水标本分离的病原菌及药敏数据进行分析。结果255例患者男性占78.04%,共检出292株病原菌,结核分枝杆菌170株,胞内分枝杆菌1株,分枝杆菌外的病原菌共121株(其中革兰阳性菌54株,革兰阴性菌55株,真菌10株,厌氧菌2株);普通细菌中链球菌属最多,且除对红霉素、克林霉素耐药率高较高外,余均较敏感;常见革兰阴性菌依次为铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌,肠杆菌目CRE的检出率较高。23例(9.02%)合并感染者中,最常见的病原体依次是革兰氏阴性菌、凝固酶阴性葡萄球菌和真菌。结论胸腔感染男性占比高,结核菌检出仍占首位,链球菌属是胸腔感染常见普通细菌,肺炎克雷伯菌等肠杆菌目细菌CRE检出率高。临床治疗应重视病原学检查,结合本地感染和耐药流行趋势,正确选择抗菌药物以提高治愈率。

Objective To investigate the distribution and drug resistance of pathogens in the pleural effusion of patients treated in tuberculosis specialized hospitals.Methods The WHONET 5.6 software was used to analyze the pathogenic bacteria and drug susceptibility data isolated from pleural effusion specimens in our hospital from January to December 2020.Results Among the 255 patients,males accounted for 78.04%,and a total of 292 strains of pathogenic bacteria were detected,including 170 Mycobacterium tuberculosis,1 intracellular Mycobacterium,and 121 pathogenic bacteria other than Mycobacterium(including 54 Gram-positive bacteria,55 Gram-negative bacteria,10 fungi,and 2 anaerobic bacteria);Streptococcus was the most common bacteria,and all were more sensitive except for the high resistance rate to erythromycin and clindamycin.The most common Gram-negative bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae,and Enterobacter cloacae,and the detection rate of Enterobacteriaceae CRE was higher.Among the 23 co-infection cases(9.02%),the most common pathogens were Gram-negative bacteria,coagulase-negative Staphylococcus and fungi.Conclusion Males account for a high proportion of thoracic infections,and Mycobacterium tuberculosis still ranks first in detection.Streptococcus is a common bacterium in pleural infections,and Klebsiella pneumoniae and other Enterobacteriaceae bacteria have a high detection rate of CRE.Clinical treatment should pay attention to the etiological examination,combined with local infection and drug resistance trends,and the correct choice of antibiotics to improve the cure rate.