摘要
目的探究肺结核并发肺部感染病原菌分布、耐药性及耐药基因情况。方法 52株病原菌分离自2013年3月-2018年4月义乌市中心医院肺结核并发肺部感染患者痰液标本,进行病原菌耐药性分析,采用聚合酶链式反应(PCR)鉴定TEM、SHV、mecA、PBP1a、PBP2b等耐药基因的表达。结果革兰阴性菌29株占55.77%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主,革兰阳性菌18株占34.62%,以金黄色葡萄球菌、肺炎链球菌为主,真菌5株占9.62%,以白假丝酵母为主;肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌对氨苄西林、哌拉西林、头孢唑林、头孢曲松、环丙沙星等药物耐药性较高,未检出亚胺培南、美罗培南耐药菌株;金黄色葡萄球菌、肺炎链球菌对青霉素、红霉素、阿奇霉素等药物耐药性较高,未检出万古霉素、替考拉宁、利奈唑胺耐药菌株;肺炎克雷伯菌检出TEM突变1株,SHV突变1株;铜绿假单胞菌、大肠埃希菌分别检出TEM突变1株;金黄色葡萄球菌检出mecA、PBP1a、PBP2b突变各1株,肺炎链球菌检出mecA突变1株,PBP1a突变1株。结论肺结核合并肺部感染患者病原菌分布复杂,且对药物表现出不同的耐药性,在临床中宜根据药敏试验结果合理选择药物,对耐药基因进行检测可为明确菌株耐药机制提供一定参考。
OBJECTIVE To explore the pathogenic bacteria of pulmonary tuberculosis with pulmonary infection and their drug resistance and drug resistance gene. METHODS Fifty-two strains of pathogenic bacteria were isolated from sputum specimens in patients with pulmonary tuberculosis complicated with pulmonary infection who were admitted to the Yiwu Central Hospital between Mar. 2013 and Apr. 2018. Drug resistance analysis was carried out, and polymerase chain reaction(PCR) was used to identify the expression of drug resistance genes such as TEM, SHV, mecA, PBP1 a and PBP2 b. RESULTS There were 29 strains of Gram-negative bacteria(55.77%), which mainly included Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, 18 strains of Gram-positive bacteria(34.62%), which mainly included Staphylococcus aureus and Streptococcus pneumoniae, and 5 strains of fungi(9.62%) which mainly included Candida albicans. K. pneumoniae, P. aeruginosa and E. coli were highly resistant to ampicillin, piperacillin, cefazolin, ceftriaxone and ciprofloxacin. No imipenem and meropenem resistant strains were detected. S. aureus and S. pneumoniae were highly resistant to penicillin, erythromycin, azithromycin and gentamicin. No vancomycin, teicoplanin and linezolid resistant strains were detected. One strain of K. pneumoniae with TEM mutation, 1 strain of K. pneumoniae with SHV mutation, 1 strain of P. aeruginosa with 1 strain of E. coli with TEM mutation, each 1 strain of S. aureus with mecA, PBP1a and PBP2b mutations, 1 strain of S. pneumoniae with mecA mutation and 1 strain with PBP1 a mutation were detected. CONCLUSION Distribution of pathogenic bacteria pulmonary tuberculosis patients complicated with pulmonary infection were complex, which showed different drug resistance. Drugs should be reasonably used according to the results of drug susceptibility in clinical practice. The detection of drug resistance genes can provide reference for the drug resistance mechanism of strains.
作者
吴霜
叶韦玮
涂俊才
楼莲青
陶兴飞
WU Shuang;YE Wei-wei;TU Jun-cai;LOU Lian-qing;TAO Xing-fei(Yiwu Central Hospital,Yiwu,Zhejiang322000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第8期1165-1168,共4页
Chinese Journal of Nosocomiology
基金
浙江省自然科学基金资助项目(2019174)。
关键词
肺结核
肺部感染
耐药性
耐药基因
Pulmonary tuberculosis
Pulmonary infection
Drug resistance
Drug resistance gene
