艾滋病合并细菌性肺炎的病原菌分布及耐药性

Distribution and antimicrobial resistance of pathogens isolated from AIDS patients with bacterial pneumonia

摘要:

目的了解艾滋病合并细菌性肺炎患者的病原菌分布和耐药状况。方法对某传染病院2008年1月—2010年2月住院的433例艾滋病合并细菌性肺炎患者标本中分离的病原菌资料进行分析。结果433例患者共分离106株病原菌，标本来源以痰液为主(90株,占 90.90%)，其余分离自胸腔积液、肺穿刺组织学标本。所分离的病原菌中，革兰阴性 （G-）杆菌77株 (72．64%)，其中非发酵菌30株 (38.96%)，肠杆菌科细菌47株 (61.04%)；革兰阳性（G+） 球菌28株 (26.42%)，以凝固酶阴性葡萄球菌最多，共15株(53.57%)；真菌1株(0.94%)。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌产超广谱β内酰胺酶（ESBLs）检出率分别为72.73%（16/22）、46.15％（6/13）、20.83%(5/24)。大肠埃希菌、肺炎克雷伯菌对亚胺培南的耐药率为0.00%, 铜绿假单胞菌对亚胺培南的耐药率为8.33%。G-杆菌除嗜麦芽窄食单胞菌外,对第三代头孢菌素的耐药率＞60.00%，对第四代头孢菌素的耐药率＞53.00%。嗜麦芽窄食单胞菌对常用头孢菌素耐药。MRCNS除对万古霉素敏感外，对其他抗菌药物耐药率较高，未发现万古霉素耐药株。结论艾滋病合并细菌性肺炎感染病原菌主要以G-杆菌为主,且耐药现象明显。药敏试验结果可以为临床用药提供一定参考。

Abstract:

ObjectiveTo study the distribution and antimicrobial resistance of pathogens in AIDS patients with bacterial  pneumonia.MethodsPathogens isolated from 433 AIDS patients  with bacterial pneumonia in a  hospital from January  2008 through  February  2010 were analysed .ResultsA total of 106 bacteria strains  were isolated from 433 patients, the main source was sputum (90 strains, 90.90%) , followed by pleural effusion and pneumocentesis histological samples. Of all  pathogens ,  77 strains (72.64%) were gramnegative bacilli，30 (38.96%) of which were nonfermentative bacteria, 47 (61.04%) were Enterobacteriaceae  bacteria;  28 of 106 (26.42%) were grampositive cocci , the majority were coagulase negative Staphylococcus (15 strains,53.57%); 1 of 106 (0.94%) was fungi. The ESBLs producing  rate of Escherichia coli, Klebsiella pneumoniae, and  Pseudomonas aeruginosa was 72.73%(16/22), 46.15% (6/13) and 20.83%(5/24) respectively. Antimicrobial resistant rate of Escherichia coli and Klebsiella pneumoniae to imipenem was 0.00%. Antimicrobial resistant rate of Pseudomonas aeruginosa to imipenem was 8.33%. Of all gramnegative bacilli , except for Stenotrophomonas maltophilia， antimicrobial resistant rate to the third and fourth generation cephalosporins was > 60.00% and > 53.00% respectively. The resistant rate of Stenotrophomonas maltophilia to commonly used cephalosporins was very high. MRCNS showed multidrugresistance except high sensitivity to vancomycin , there was no resistant strain to vancomycin in all MRCNS.ConclusionThe main pathogens in AIDS patients with bacterial pneumonia are gramnegative bacilli, and  drug resistance is obvious. Antimicrobial  susceptibility test result  can provide reference for clinical application of antimicrobial agents .