摘要
目的探讨住院结核病患者下呼吸道感染的病原体分布特点及耐药情况,为临床合理使用抗菌药物提供科学依据。方法对2008—2011年住院结核病患者痰标本进行常规细菌分离培养,用VITEK-2 Compact全自动微生物分析仪进行细菌鉴定及药敏试验。结果共分离出病原体2 354株,其中革兰阴性菌1 007株(占42.8%),革兰阳性菌292株(占12.4%),真菌1 055株(占44.8%)。革兰阴性菌前3位依次为肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌,前两者对大多数抗菌药物的耐药率均在50%以下,而大肠埃希菌产超广谱β-内酰胺酶(ESBLs)菌株占60%以上,但其对头孢哌酮/舒巴坦、亚胺培南和美罗培南全部敏感。革兰阳性菌以金黄色葡萄球菌居首,其中耐甲氧西林金黄色葡萄球菌(MRSA)占70%以上,为多重耐药菌株,未发现对万古霉素、利奈唑烷和替加环素耐药的菌株。真菌以白色念珠菌和丝状真菌为主,对常用抗真菌药物的耐药率均在30%以下。结论产ESBLs的大肠埃希菌、MRSA导致的多重耐药以及革兰阴性菌和真菌感染率的逐渐增加,应当引起足够的重视。加强临床病原体及其耐药性的监测,对于合理使用抗菌药物,有效控制结核病患者下呼吸道感染及减缓耐药菌株的产生与发展具有重要意义。
Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria causing lower respiratory tract infections in hospitalized patients with tuberculosis, so as to provide a scientific evidence for clinically rea- sonable use of antibiotics. Methods Sputum specimens from hospitalized tuberculosis patients from 2008 to 2011 were obtained for routine bacterial isolation and culture. The VITEK - 2 Compact automated microbial analyzer was used for identifying the iso- lated strains and for susceptibility testing. Results A total of 2 354 bacterial strains were isolated, in which Gram - negative ba- cilli accounted for 1 007 stains （42. 8% ）, Gram - positive cocci accounted for 292 stains （ 12.4% ）, and fungi accounted for 1 055 stains （44. 8% ）. Gram - negative bacilli of the top three were Klebsiella pneumoniae, Pseudomonas aeruginosa and Esch- erichia coll. The drug resistance rates of the first two to the majority of antibiotics were below 50%. ESBLs - producing strains in Eseherichia coil accounted for more than 60%, but these strains were all sensitive to cefoperazone/sulbactam, imipenem and meropenem. Staphylococcus aureus ranked the first in Gram - positive cocci, of which MRSA accounted for more than 70%, be- ing multipledrug- resistant strain. But no strains resistant to vancomycin, linezolid, and tigecycline were found. The main pathogens in fungi were Candida albicans and filamentous fungi, whose resistance rates to commonly used antifungal agents were below 30%. Conclusion The multi - drug resistance caused by ESBLs - producing strains in Escherichia coli, and MRSA, as well as the infection rate caused by gram - negative bacilli and fungi have been gradually increased, which should be taken seri- ously. The monitoring of clinical pathogens and their drug resistance should be strengthened. It is of great significance to use an- tibiotics rationally, control the infection of lower respiratory tract in tuberculosis patients effectively, and reduce the occurrence o
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第10期1178-1180,共3页
Chinese General Practice
关键词
结核病
呼吸道感染
病原体
分布
耐药性
Tuberculosis
Respiratory tract infections
Pathogen
Distribution
Drug resistance
