南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (08): 1192-.

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肺结核并重症肺炎行有创机械通气患者下呼吸道病原菌分布及耐药性特点

劳穗华,王娟,俞朝贤,李德宪   

  • 出版日期:2014-08-20 发布日期:2014-08-20

Distribution and drug-resistance of bacteria in the lower respiratory tract in patients with
tuberculosis and severe pneumonia receiving invasive mechanical ventilation

  • Online:2014-08-20 Published:2014-08-20

摘要: 目的探讨肺结核合并重症肺炎行有创机械通气行下呼吸道感染的病原菌分布及耐药性特点。方法对我院2006年1月~
2013年1月收治的肺结核合并重症肺炎行有创机械通气的患者共208例进行统计分析,记录下呼吸道感染病原菌构成及药物敏
感率。结果208 例样本成功分离出病株355 株。细菌培养结果以革兰氏阴性菌为主(281 株,占79.2%);其次为真菌(62 株,
17.5%)和革兰氏阳性菌(12株,占3.4%)。其中混合感染68例,占19.2%。对革兰氏阴性杆菌敏感率在60%以上的抗生素有美
洛培南、亚胺培南和阿米卡星。替考拉宁、万古霉素、夫地西酸对革兰氏阳性菌敏感率为100%。结论革兰氏阴性菌、真菌和革
兰氏阳性菌是肺结核合并重症肺炎行有创机械通气患者下呼吸道感染的最主要致病菌;亚胺培南、美洛培南、和阿米卡星是有
效的治疗药物;我院肺结核合并重症肺炎行有创机械通气患者存在多重耐药性,应坚持病原菌培养和药敏试验,根据试验结果
合理选用抗生素。

Abstract: Objective To investigate the distribution and drug-resistance of bacteria in the lower respiratory tract in patients
with tuberculosis and severe pneumonia receiving invasive mechanical ventilation. Methods The clinical data, lower
respiratory tract infection pathogens and bacterial drug sensitivity were analyzed in 208 patients receiving invasive mechanical
ventilation for tuberculosis and severe pneumonia. Results A total of 355 pathogenic microbial strains were obtained from the
patients, among which 281 (79.2% ) strains were Gram-negative bacteria, 62 (17.5% ) were fungi, and 12 (3.4% ) were
Gram-positive bacteria. Mixed infections were found in 68 cases (19.2%). The sensitivity rates of meropenem, imipenem and
amikacin were over 60% for Gram-negative bacteria, and those of teicoplanin, vancomycin, and fusidic acid were 100% for
Gram-positive bacteria. Conclusion The main pathogenic bacteria are Gram-negative bacteria, fungi and Gram-positive
bacteria in the lower respiratory tract of patients with tuberculosis and severe pneumonia receiving mechanical ventilation.
Meropenem, imipenem and amikacin are effective antibiotics for lower respiratory tract infections, and multi-drug resistance
is frequent in these patients, which urges appropriate use of the antibiotics.