摘要
目的分析云南省住院HIV/AIDS患者合并伤口感染的病原菌分布特点,为临床诊疗提供依据。方法回顾性分析云南省传染病医院2016—2020年住院HIV/AIDS患者分泌物或脓液标本检出阳性的294名患者的临床资料。结果294份病例中分离出病原菌357株,其中革兰阴性杆菌(G-b)123株,占比34.5%,以大肠埃希菌(15.4%)、肺炎克雷伯菌(3.9%)、铜绿假单胞菌(3.6%)为主;革兰阳性杆菌(G+b)14株,占比3.9%;革兰阳性球菌(G+c)108株,占比30.3%,其中凝固酶阳性的金黄色葡萄球菌44株(12.3%),凝固酶阴性葡萄球菌以表皮葡萄球菌(4.2%)、溶血葡萄球菌(2.8%)为主;真菌37株,占比10.4%,主要为白色假丝酵母(5.9%);分枝杆菌75株,占比21.0%。其中结核分枝杆菌41株(11.5%),非结核分枝杆菌34株(9.5%)。294例HIV/AIDS患者中有52例为混合感染,占比17.7%。不同标本来源中G+c、G-b、分枝杆菌和混合感染四类病原菌的分布差异有统计学意义(P<0.05),不同CD4+T淋巴细胞计数之间分枝杆菌的分布差异有统计学意义(P<0.05)。不同年龄段的患者CD4+T淋巴细胞水平差异有统计学意义(P<0.05),标本来源于术后切口与来源于其他部位的CD4+T淋巴细胞水平差异有统计学意义(P<0.05)。结论HIV/AIDS患者易合并各种病原菌的伤口感染,对该类患者应及时送检分泌物或脓液培养,特别是对CD4+T淋巴细胞数量低的患者应及时送检,从而对患者进行有针对性的治疗,改善患者的预后。
Objective To analyze the distribution characteristics of the main pathogens of HIV/AIDS patients with wound infections and provide basis for clinical diagnosis and treatment.Methods The clinical data of 294 patients with positive secretions or pus specimens from 2016 to 2020 were analyzed retrospectively.Results A total of 357 strains of pathogenic bacteria were isolated from 294 cases, of which 123 strains of Gram-negative bacilli(G-b), accounting for 34.5%,were mainly Escherichia coli(15.4%), Klebsiella pneumoniae(3.9%), and Pseudomonas aeruginosa(3.6%);Gram-positive bacilli(G+b) 14 strains, accounting for 3.9%;108 Gram-positive cocci(G+c), accounting for 30.3%, of which 44 strains were coagulase-positive Staphylococcus aureus(12.3%), Coagulase-negative staphylococci were mainly Staphylococcus epidermidis(4.2%) and Staphylococcus hemolyticus(2.8%);37 strains of fungi, accounting for 10.4%, were mainly Candida albicans(5.9%);75 strains of Mycobacterium, accounting for 21.0%, including 41 strains of Mycobacterium tuberculosis(11.5%) and 34 strains of non-tuberculosis mycobacteria(9.5%). 52 of the 294 HIV/AIDS patients had mixed infections, accounting for 17.7%. There was significant difference in the distribution of G+c, G-b, mycobacteria and mixed infection among different specimen sources(P<0.05), and there was significant difference in the distribution of mycobacteria among different CD4+T lymphocyte counts(P<0.05). There was significant difference in the level of CD4+T lymphocytes between patients of different ages(P<0.05), and there was significant difference in the level of CD4+T lymphocytes from postoperative incision and other parts(P<0.05).Conclusions Patients with HIV/AIDS are prone to combined wound infections with various pathogenic bacteria. We should strengthen the research on wound infection in HIV/AIDS patients, and timely send patients with a low number of CD4+T lymphocytes for secretion or pus culture, so as to carry out targeted treatment and improve the prognosis of patients.
作者
李梦学
刘家法
张芮
李正伦
李健健
邓雪媚
代佳伟
张米
董兴齐
LI Meng-xue;LIU Jia-fa;ZHANG Rui;LI Zheng-lun;LI Jian-jian;DENG Xue-mei;DAI Jia-wei;ZHANG Mi;DONG Xing-qi(School of Public Health,Kunming Medicine University,Kunming,Yunnan 650000,China;Department of Clinical Laboratory,Yunnan Provincial Infectious Diseases Hospital/AIDS CareCenter,Kunming,Yunnan 650301,China)
出处
《中国热带医学》
CAS
2023年第1期33-38,共6页
China Tropical Medicine
基金
云南省高层次卫生技术人才培养经费资助项目(No.H-2019047)
云南省科技厅重大科技专项计划(No.202102AA310005)
云南省科技厅昆明医科大学应用基础研究联合专项基金项目(No.202001AY070001-104)
云南省教育厅科学研究基金项目(No.2022Y202)。
