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目的了解艾滋病(AIDS)患者发生肺部感染的病原菌分布及其耐药性,为临床治疗AIDS发生肺部感染患者使用抗菌药物提供依据。方法收集2010年1月-2014年8月在医院就诊的197例AIDS发生肺部感染患者的痰标本,对其进行痰培养及药物敏感试验,按照《全国临床检验操作规程》,将送检的痰标本采用常规方法进行标本接种及病原菌分离,药敏结果参照CLSI推荐的最新标准判定。结果送检痰标本中培养出病原菌112株,其中革兰阴性菌60株占53.5%、革兰阳性菌5株占4.5%、真菌47株占42.0%;同时混合≥2种病原菌感染的有13例,占11.6%;鲍氏不动杆菌对β-内酰胺类耐药率为38.1%~90.5%,铜绿假单胞菌耐药率为7.1%~85.7%,大肠埃希菌对喹诺酮类耐药率为41.7%~50.0%,肺炎克雷伯菌对氨基糖苷类耐药率为42.9%~57.1%。结论 AIDS患者肺部感染常同时存在多种病原菌,且以革兰阴性菌与真菌为主,呈现混合感染、多药耐药现象,应根据药敏试验结果正确选择抗菌药物。
Objective To understand the distribution and drug resistance of pathogens causing pulmonary infection in AIDS patients and provide basis for clinical use of antimicrobial agents in the treatment of AIDS patients with pulmonary infection. Methods A total of 197 sputum samples from patients with AIDS-related pulmonary infection were collected from January 2010 to August 2014 in our hospital. The sputum samples were collected for sputum culture and drug susceptibility tests. According to the “National Clinical Laboratory Procedures” Sputum specimens using routine methods of inoculum and pathogen isolation, drug susceptibility results with reference CLSI recommended the latest criteria. Results There were 112 pathogens in sputum samples, of which 60 were gram-negative bacteria, 53.5% were gram-negative bacteria, 4.5% were gram-positive bacteria and 47% were fungi, accounting for 42.0%. In the meantime, there were 13 Cases, accounting for 11.6%; Acinetobacter baumannii resistance rate of β-lactam 38.1% to 90.5%, Pseudomonas aeruginosa drug resistance rate of 7.1% to 85.7%, Escherichia coli quinolone resistance The drug-resistant rates ranged from 41.7% to 50.0%. The resistant rate of Klebsiella pneumoniae to aminoglycosides ranged from 42.9% to 57.1%. Conclusions There are many kinds of pathogenic bacteria in the lungs of AIDS patients at the same time. Gram - negative bacteria and fungi are the main pathogens of mixed infection and multidrug resistance in AIDS patients. Antibacterial drugs should be selected according to the results of drug sensitivity test.