肺结核患者医院感染病原菌与影像学特征

Pathogens and imaging features of nosocomial infection in patients with pulmonary tuberculosis

目的分析肺结核患者医院感染病原菌及影像学特征。方法回顾性分析2015年3月-2016年4月医院收治的肺结核医院感染患者78例为研究对象,另选取同期肺结核患者未发生医院感染78例。分析感染患者病原菌特点及影像学特征;分析患者年龄、住院时间,基础疾病等临床资料,归纳肺结核患者医院感染的影响因素。结果肺结核医院感染患者以下呼吸道感染为主。78例患者痰液中共培养分离病原菌97株,其中革兰阴性菌37株占38.14%,以肺炎克雷伯菌为主;革兰阳性菌14株占14.43%,以肠球菌属为主;真菌46株占47.42%,以白假丝酵母为主。真菌和细菌感染部位差异无统计学意义,肺结核医院感染患者CT表现:累及单个肺叶占8.97%(7/78),累及两个肺叶占87.18%(68/78),累及三个或以上肺叶占7.69%(6/78),空洞占33.33%(26/78),支气管播散占62.82%(49/78),胸腔积液占42.31%(33/78)。住院时间、抗感染药物使用、基础疾病、侵入性操作是肺结核患者医院感染的影响因素(P<0.05)。结论肺结核患者医院感染病原菌以真菌与革兰阴性菌为主,经CT影像学诊断呈双肺弥漫性病变。

OBJECTIVE To analyze the pathogens and imaging features of nosocomial infection in patients with pulmonary tuberculosis.METHODS 78 cases of pulmonary tuberculosis complicated with nosocomial infection in our hospital from Mar.2015 to Apr.2016 were retrospectively analyzed,and another 78 pulmonary tuberculosis patients not complicated with nosocomial infection were included as the control group.The characteristics of pathogens and imaging features of the infected patients were analyzed,as well as the clinical data of the patients such as age,hospitalization time and underlying diseases,and the influencing factors of nosocomial infection in pulmonary tuberculosis patients were summarized.RESULTS The nosocomial infection of pulmonary tuberculosis patients was dominated by lower respiratory tract infection.From the sputum of the 78 pulmonary tuberculosis patients with nosocomial infection,97 strains of pathogens were isolated,of which 37 strains of gram-negative bacteria accounted for 38.14%,mainly Klebsiella pneumoniae;14 strains of gram-positive bacteria accounted for 14.43%,mainly Enterococcus;and 46 strains of fungi accounted for 47.42%,mainly Candida albicans.There were no significant differences in fungal and bacterial infection sites.According to the CT findings in patients with pulmonary tuberculosis and nosocomial infections,8.97%(7/78)of the patients suffered from infection in a single lobe,87.18%(68/78)suffered from infection in two lobes and 7.69%(6/78)had infection in three or more lobes,cavity accounted for 33.33%(26/78),bronchiectasis accounted for 62.82%(49/78),and pleural effusion accounted for 42.31%(33/78).Hospitalization time,use of anti-infective drugs,underlying diseases and invasive operation were the influencing factors of nosocomial infection in tuberculosis patients(P<0.05).CONCLUSION The pathogens of pulmonary tuberculosis patients complicated with nosocomial infection are mainly Candida and gram-negative bacteria,and diffuse lung lesions were diagnosed by CT imaging.