肺结核患者合并社区获得性肺炎的病原菌分布与耐药菌分析
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摘要
目的分析肺结核合并社区获得性肺炎患者菌群分布特点及耐药风险因素分析。方法选取2017年4月-2018年4月在本院确诊为社区获得性肺炎的结核杆菌感染的患者60例为研究对象作为观察组,并以同期非结核的社区性获得性肺炎患者60例作为对照组,所有患者均进行病原学诊断,探讨肺结核合并社区获得性肺炎患者菌群分布特点并进行耐药分析,分析肺结核患者耐药菌感染的风险因素。结果观察组革兰阴性菌的发病率明显高于对照组;观察组对头孢曲松、氨曲南、莫西沙星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、万古霉素、头孢噻肟的耐药率均明显高于对照组;肺结核病程、肺功能、抗生素使用史是肺结核患者社区获得性肺炎耐药菌感染的独立危险因素(P<0.05)。结论肺结核病程、肺功能、抗生素使用史是患者耐药感染的独立风险因素,积极分析患者耐药菌感染的临床因素,有助于患者恢复病情。
Objective To analyze the bacterial distribution and drug resistance risk factors of pulmonary tuberculosis patients with community acquired pneumonia. Methods 60 patients with community acquired pneumonia diagnosed in our hospital from April 2017 to April 2018 were selected as the observation group, and 60 patients with non-tuberculosis community acquired pneumonia were selected as the control group. All the patients were etiologically diagnosed to explore the community acquired tuberculosis patients. Distribution characteristics of bacteria in patients with acquired pneumonia and drug resistance analysis were carried out to analyze the risk factors of drug-resistant bacteria infection in patients with pulmonary tuberculosis. Results The incidence rate of Gram-negative bacteria in the observation group was higher than that in the control group. The resistance rates of ceftriaxone, aztreonam, moxifloxacin, Cefoperazone/sulbactam, piperacillin/tazobactam, vancomycin and cefotaxime in the observation group were significantly higher than those in the control group. Course of pulmonary tuberculosis, pulmonary function, antibiotic use history were independent risk factors of community acquired pneumonia drug-resistant bacteria infection in pulmonary tuberculosis patients. Conclusion The course of tuberculosis, pulmonary function and antibiotic use history are independent risk factors for drug-resistant infection.
Objective To analyze the bacterial distribution and drug resistance risk factors of pulmonary tuberculosis patients with community acquired pneumonia. Methods 60 patients with community acquired pneumonia diagnosed in our hospital from April 2017 to April 2018 were selected as the observation group, and 60 patients with non-tuberculosis community acquired pneumonia were selected as the control group. All the patients were etiologically diagnosed to explore the community acquired tuberculosis patients. Distribution characteristics of bacteria in patients with acquired pneumonia and drug resistance analysis were carried out to analyze the risk factors of drug-resistant bacteria infection in patients with pulmonary tuberculosis. Results The incidence rate of Gram-negative bacteria in the observation group was higher than that in the control group. The resistance rates of ceftriaxone, aztreonam, moxifloxacin, Cefoperazone/sulbactam, piperacillin/tazobactam, vancomycin and cefotaxime in the observation group were significantly higher than those in the control group. Course of pulmonary tuberculosis, pulmonary function, antibiotic use history were independent risk factors of community acquired pneumonia drug-resistant bacteria infection in pulmonary tuberculosis patients. Conclusion The course of tuberculosis, pulmonary function and antibiotic use history are independent risk factors for drug-resistant infection.
引文
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[13] 卢春丽,谭守勇,江涛,等.应用NRS2002方法对肺结核合并肺部感染患者的营养风险筛查和分析[J].临床肺科杂志,2014,12(7):1273-1274,1275.
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[15] 李华.肺结核耐药和耐多药的危险因素分析[J].中国实用医刊,2018(12):69-72.
[2] 巨清.NLR和MPV在肺结核与细菌性社区获得性肺炎鉴别诊断中的临床价值[D].济南:山东大学,2016.
[3] 赵军喜.血清降钙素原及C反应蛋白在社区获得性肺炎和肺结核中的诊断价值分析[J].中国处方药,2016,14(6):653-655.
[4] 吴智龙,张明,刘英.肺结核合并肺部感染的临床特征及病原学研究[J].临床肺科杂志,2006,8(6):767-768.
[5] 胡族琼,李雪雅,胡琳燕,等.血浆(1,3)-β-D葡聚糖检测对肺结核患者肺部真菌感染诊断价值的初步研究[J].实用医学杂志,2017,5(10):1615-1618.
[6] 陈立鹏,刘灶松,陈亮,等.以双肺多发空洞为主要表现的曲菌病及肺结核CT鉴别诊断[J].中国CT和MRI杂志,2018,7(1):60-62.
[7] 王锦萍,蔡常辉,梁连辉,等.肺结核并发肺部感染凝固酶阴性葡萄球菌的耐药性及耐药基因mecA分析[J].国际检验医学杂志,2018,12(5):623-625.
[8] 宋昆,李长罗.肺结核并发肺部真菌感染56例临床分析[J].临床和实验医学杂志,2007,6(2):13-13,15.
[9] 曹雪如.肺结核合并肺部感染患者的病原菌耐药性分析[J].国际呼吸杂志,2016,9(10):735-738.
[10] 沈小波.肺结核合并肺部真菌感染的多因素Logistical回归分析[J].临床肺科杂志,2016,21(11):2095-2096,2097.
[11] 邬恒燕.肺结核合并肺部感染的病原体特点及危险因素分析[J].中国基层医药,2015,8(7):1018-1020.
[12] 过丽芳,贺伟,王仁贵,等.肺结核并发肺部真菌感染的CT表现特征分析[J].中国防痨杂志,2017,5(6):570-575.
[13] 卢春丽,谭守勇,江涛,等.应用NRS2002方法对肺结核合并肺部感染患者的营养风险筛查和分析[J].临床肺科杂志,2014,12(7):1273-1274,1275.
[14] 徐莉娟,刘华.肺结核耐药情况及影响因素分析[J].传染病信息,2018(3):258-260.
[15] 李华.肺结核耐药和耐多药的危险因素分析[J].中国实用医刊,2018(12):69-72.